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General NPI Number Information
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NPI Number | 1497534663
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Entity Type | Organization
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Legal Business Name | SERAPHIM MENTAL WHOLENESS
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 2626 COLE AVE STE 300
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City | DALLAS
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State | TX
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Zip | 75204-1094
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Country | US
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Telephone | 469-340-1849
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Fax | 469-809-7865
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Provider Business Mailing Address
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Address Line | 2626 COLE AVE STE 300
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City | DALLAS
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State | TX
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Zip | 75204-1094
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Country | US
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Telephone | 469-340-1849
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Fax | 469-809-7865
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Authorized Official
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Title or Position | OWNER
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Name | ABIDEMI L OLUSANYA
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Credential |
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Telephone | 469-340-1849
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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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