=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922791110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL SOOTHE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2023
-----------------------------------------------------
Last Update Date | 06/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13810 CHAMPION FOREST DR STE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-1883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-702-3702
-----------------------------------------------------
Fax | 832-234-7593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13810 CHAMPION FOREST DR STE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-1883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-702-3702
-----------------------------------------------------
Fax | 832-234-7593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC MENTAL HEALTH NP
-----------------------------------------------------
Name | RASHEEDAT KOLEOSHO
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 832-702-3702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------