1942922703 NPI number — TEXAS MIND BEHAVIOR AND PSYCHIATRIC CLINIC LLC

Table of content: (NPI 1942922703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942922703 NPI number — TEXAS MIND BEHAVIOR AND PSYCHIATRIC CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS MIND BEHAVIOR AND PSYCHIATRIC CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1942922703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 E DEBBIE LN # 2305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-407-1172
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 BALCONES DR # 8229
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-4257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-407-1172
Provider Business Practice Location Address Fax Number:
682-222-7024
Provider Enumeration Date:
09/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ESENE
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
EHIGIE
Authorized Official Title or Position:
OWNER NP
Authorized Official Telephone Number:
469-407-1172

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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