Provider Demographics
NPI:1992436729
Name:BROADMOOR BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BROADMOOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-266-1747
Mailing Address - Street 1:PO BOX 19895
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-5895
Mailing Address - Country:US
Mailing Address - Phone:504-266-1747
Mailing Address - Fax:
Practice Address - Street 1:2500 WILCREST DR STE 403
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2752
Practice Address - Country:US
Practice Address - Phone:504-266-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No343800000XTransportation ServicesSecured Medical Transport (VAN)