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General NPI Number Information
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NPI Number | 1053156331
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Entity Type | Organization
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Legal Business Name | REHOBOTH MENTAL HEALTH AND PSYCHIATRY PLLC
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Dates
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Enumeration Date | 06/27/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1475 HERITAGE PKWY STE 209
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City | MANSFIELD
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State | TX
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Zip | 76063-2740
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Country | US
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Telephone | 817-523-8812
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Fax | 817-241-1947
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Provider Business Mailing Address
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Address Line | 1475 HERITAGE PKWY STE 209
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City | MANSFIELD
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State | TX
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Zip | 76063-2740
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Country | US
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Telephone | 817-523-8812
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORISED OFFICIAL
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Name | OMOTAYO GBENGAOJO
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Credential |
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Telephone | 817-523-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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