Provider Demographics
NPI:1174110134
Name:EDIFY BEHAVIORAL MANAGEMENT LLC
Entity type:Organization
Organization Name:EDIFY BEHAVIORAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:LAVALLE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-808-0425
Mailing Address - Street 1:2000 S DAIRY ASHFORD RD STE 575
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5737
Mailing Address - Country:US
Mailing Address - Phone:832-808-0425
Mailing Address - Fax:832-218-0204
Practice Address - Street 1:2000 S DAIRY ASHFORD RD STE 575
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5737
Practice Address - Country:US
Practice Address - Phone:832-808-0425
Practice Address - Fax:832-218-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4181307Medicaid