Healthcare Provider Details

I. General information

NPI: 1053236224
Provider Name (Legal Business Name): MENDING PEACE AND PURPOSE MENTAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 5TH ST STE A
CONROE TX
77301-3615
US

IV. Provider business mailing address

211 S 5TH ST STE A
CONROE TX
77301-3615
US

V. Phone/Fax

Practice location:
  • Phone: 346-923-5501
  • Fax:
Mailing address:
  • Phone: 346-923-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PAULINUS ERESAMA
Title or Position: CEO/PROVIDER
Credential: PMHNP-BC
Phone: 346-923-5501