Provider Demographics
NPI:1528783016
Name:PILGRIMAGE OF HOPE BEHAVIORAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:PILGRIMAGE OF HOPE BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SIMMONS-MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNP-BC
Authorized Official - Phone:504-473-0409
Mailing Address - Street 1:240 W GALVESTON ST UNIT 1555
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-1249
Mailing Address - Country:US
Mailing Address - Phone:346-704-4163
Mailing Address - Fax:
Practice Address - Street 1:811 HARVARD POINTE DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4776
Practice Address - Country:US
Practice Address - Phone:504-473-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health