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General NPI Number Information
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NPI Number | 1942922703
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Entity Type | Organization
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Legal Business Name | TEXAS MIND BEHAVIOR AND PSYCHIATRIC CLINIC LLC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR # 8229
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 469-407-1172
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Fax | 682-222-7024
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Provider Business Mailing Address
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Address Line | 1301 E DEBBIE LN # 2305
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City | MANSFIELD
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State | TX
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Zip | 76063-3305
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Country | US
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Telephone | 469-407-1172
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Fax |
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Authorized Official
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Title or Position | OWNER NP
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Name | LLOYD EHIGIE ESENE
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Credential |
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Telephone | 469-407-1172
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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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