Healthcare Provider Details

I. General information

NPI: 1932810462
Provider Name (Legal Business Name): AGAPE PSYCHIATRY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 CASTLE CREEK DRIVE
LITTLE ELM TX
75068
US

IV. Provider business mailing address

2801 CASTLE CREEK DR
LITTLE ELM TX
75068-0340
US

V. Phone/Fax

Practice location:
  • Phone: 469-456-9907
  • Fax:
Mailing address:
  • Phone: 240-645-3390
  • 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: DR. STELLA OLUWAFUNMIKE ADEBUSOYE
Title or Position: OWNER
Credential: DNP, PMHNP, FNP, BC
Phone: 240-645-3390