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General NPI Number Information
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NPI Number | 1154744266
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Entity Type | Organization
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Legal Business Name | PUISSANT LLC DBA INTEGRATED MINDS
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 4107 CROSSPOINT BLVD SUITE A
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-329-7764
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Fax | 956-329-7766
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Provider Business Mailing Address
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Address Line | 4107 CROSSPOINT BLVD SUITE A
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-329-7764
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Fax | 956-329-7766
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Authorized Official
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Title or Position | OFFICER/MEMBER
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Name | DR. YEMI ADEBOWALE
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 832-419-3267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 770332
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License Number State | TX
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