Healthcare Provider Details

I. General information

NPI: 1215751466
Provider Name (Legal Business Name): CHRISTIAN OGALA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 KELLER SPRINGS RD STE 801
CARROLLTON TX
75006-4875
US

IV. Provider business mailing address

2840 KELLER SPRINGS RD STE 801
CARROLLTON TX
75006-4875
US

V. Phone/Fax

Practice location:
  • Phone: 469-579-8417
  • Fax:
Mailing address:
  • Phone: 469-579-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1179574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: