Provider Demographics
NPI:1386337004
Name:ABISOM BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:ABISOM BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:KAYODE
Authorized Official - Last Name:SOFELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-361-8577
Mailing Address - Street 1:15 SPRINGTIME CREEK DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4163
Mailing Address - Country:US
Mailing Address - Phone:832-361-8577
Mailing Address - Fax:
Practice Address - Street 1:15 SPRINGTIME CREEK DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77354-4163
Practice Address - Country:US
Practice Address - Phone:832-361-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty