Healthcare Provider Details

I. General information

NPI: 1053156331
Provider Name (Legal Business Name): REHOBOTH MENTAL HEALTH AND PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 HERITAGE PKWY STE 209
MANSFIELD TX
76063-2740
US

IV. Provider business mailing address

1475 HERITAGE PKWY STE 209
MANSFIELD TX
76063-2740
US

V. Phone/Fax

Practice location:
  • Phone: 817-523-8812
  • Fax: 817-241-1947
Mailing address:
  • Phone: 817-523-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OMOTAYO GBENGAOJO
Title or Position: OWNER/AUTHORISED OFFICIAL
Credential:
Phone: 817-523-8812