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General NPI Number Information
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NPI Number | 1215708045
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Entity Type | Organization
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Legal Business Name | EFFULGENCE MENTAL & BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 9500 MEDICAL CENTER DR STE 270
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City | LARGO
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State | MD
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Zip | 20774-3709
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Country | US
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Telephone | 877-306-2758
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Fax | 877-306-2754
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Provider Business Mailing Address
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Address Line | 2905 DUSTYWOOD DR
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City | MCKINNEY
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State | TX
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Zip | 75071-6783
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Country | US
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Telephone | 972-900-3652
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Fax | 877-306-2754
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Authorized Official
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Title or Position | PRESIDENT
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Name | IFEOMA IROKWE
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Credential | PMHNP
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Telephone | 972-900-3652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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