Healthcare Provider Details

I. General information

NPI: 1538999370
Provider Name (Legal Business Name): PREMIUM PSYCHIATRY & MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 W UNIVERSITY DR
DENTON TX
76201-0644
US

IV. Provider business mailing address

424 ORLEANS DR
SOUTHLAKE TX
76092-1128
US

V. Phone/Fax

Practice location:
  • Phone: 940-320-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAWWAD YUSUF
Title or Position: MANAGER
Credential: MD
Phone: 214-814-5507