Healthcare Provider Details

I. General information

NPI: 1841169653
Provider Name (Legal Business Name): EMEM TITUS BASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21352 PROVINCIAL BLVD
KATY TX
77450-7580
US

IV. Provider business mailing address

21352 PROVINCIAL BLVD
KATY TX
77450-7580
US

V. Phone/Fax

Practice location:
  • Phone: 832-779-7074
  • Fax: 281-829-7331
Mailing address:
  • Phone: 713-409-2710
  • Fax: 281-829-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1003158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: