Provider Demographics
NPI:1801553342
Name:MOMENTUM MINDS BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:MOMENTUM MINDS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YANEKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-815-8929
Mailing Address - Street 1:21306 RUSSELL CHASE DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-7114
Mailing Address - Country:US
Mailing Address - Phone:832-815-8929
Mailing Address - Fax:
Practice Address - Street 1:21306 RUSSELL CHASE DR
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-7114
Practice Address - Country:US
Practice Address - Phone:832-815-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)