Healthcare Provider Details

I. General information

NPI: 1528962545
Provider Name (Legal Business Name): EMMANUEL CARE BEHAVIORAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 N ORACLE RD STE 157
TUCSON AZ
85704-4283
US

IV. Provider business mailing address

2666 LA JOLLA BLVD
GRAND PRAIRIE TX
75054-0297
US

V. Phone/Fax

Practice location:
  • Phone: 469-530-4932
  • Fax:
Mailing address:
  • Phone: 469-530-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: RONIE EMMANUEL
Title or Position: OWNER
Credential:
Phone: 469-530-4932