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General NPI Number Information
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NPI Number | 1639862089
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Entity Type | Organization
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Legal Business Name | WINDHAM PYSCHIATRY P.C.
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 2412 N GRANDVIEW AVE STE 201
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City | ODESSA
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State | TX
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Zip | 79761-1631
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Country | US
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Telephone | 432-352-9767
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 N GRANDVIEW AVE STE 201
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City | ODESSA
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State | TX
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Zip | 79761-1631
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Country | US
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Telephone | 432-352-9767
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | SANDRA NICOLE WINDHAM
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Credential |
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Telephone | 143-235-2976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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