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General NPI Number Information
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NPI Number | 1083501951
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Entity Type | Organization
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Legal Business Name | FUQUA PSYCHIATRIC CONSULTING PLLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 420 N CARROLL AVE STE 150
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6454
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Country | US
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Telephone | 210-201-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 420 N CARROLL AVE STE 150
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6454
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Country | US
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Telephone | 210-201-3316
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ADRIENNE CARDENAS
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Credential |
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Telephone | 210-201-3316
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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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