Healthcare Provider Details

I. General information

NPI: 1124593199
Provider Name (Legal Business Name): KUPONYA TELEPSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WILCREST DR STE 300
HOUSTON TX
77042-2754
US

IV. Provider business mailing address

2500 WILCREST DR STE 300
HOUSTON TX
77042-2754
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-6409
  • Fax:
Mailing address:
  • Phone: 888-909-6409
  • Fax: 364-888-5268

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: JACQUELIN JOFFRAY
Title or Position: MANAGING MEMBER/OWNER
Credential: APRN
Phone: --