Healthcare Provider Details

I. General information

NPI: 1083359566
Provider Name (Legal Business Name): JOYFUL MIND MOBILE TMS TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 FORT LARAMIE DR
KATY TX
77449-3311
US

IV. Provider business mailing address

2218 FORT LARAMIE DR
KATY TX
77449-3311
US

V. Phone/Fax

Practice location:
  • Phone: 347-806-7648
  • Fax: 860-783-5590
Mailing address:
  • Phone: 347-806-7648
  • Fax: 860-783-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GADALLA M MAKAR
Title or Position: OWNER
Credential: MD
Phone: 347-806-7648