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General NPI Number Information
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NPI Number | 1245153618
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Entity Type | Organization
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Legal Business Name | EMINENCE PSYCHIATRIC & WELLNESS CENTER
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 2615 LOXLEY DR
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City | VENUS
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State | TX
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Zip | 76084-3170
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Country | US
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Telephone | 469-218-5355
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Fax | 469-250-0674
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Provider Business Mailing Address
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Address Line | 2100 N HWY 360 STE 403B
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-1025
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Country | US
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Telephone | 469-218-5355
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Fax | 469-250-0674
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Authorized Official
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Title or Position | OWNER
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Name | OMOWUNMI RACHAEL AYENI
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Credential | PMHNP
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Telephone | 469-369-3580
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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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