MEDICARE: SERENITY FAMILY PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1588491880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY FAMILY PSYCHIATRY

Provider Business Mailing Address
First Line	:	21311 TREBUCHET DR # TX
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1475
Country	:	US
Telephone Number	:	128-150-3467
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 CYPRESS CREEK PKWY STE 240
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3447
Country	:	US
Telephone Number	:	128-150-3467
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA S MBANG
Credential	:
Telephone Number	:	281-503-4673

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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