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General NPI Number Information
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NPI Number | 1376250613
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Entity Type | Organization
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Legal Business Name | WIN PSYCHIATRY
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 4407 EMERALD LEAF DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5545
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Country | US
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Telephone | 443-600-8858
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Fax | 817-225-2492
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Provider Business Mailing Address
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Address Line | 4407 EMERALD LEAF DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5545
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Country | US
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Telephone | 443-600-8858
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Fax | 817-225-2492
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | HENRY EHIZOKHALE
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Credential | MSN, APRN, PMHNP-BC
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Telephone | 443-600-8858
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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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