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General NPI Number Information
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NPI Number | 1962201855
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Entity Type | Organization
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Legal Business Name | EAST TEXAS PSYCHIATRY AND COUNSELING PLLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 100 INDEPENDENCE PL STE 307
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City | TYLER
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State | TX
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Zip | 75703-1328
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Country | US
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Telephone | 430-288-5800
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Fax | 800-797-3780
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Provider Business Mailing Address
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Address Line | 100 INDEPENDENCE PL STE 307
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City | TYLER
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State | TX
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Zip | 75703-1328
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Country | US
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Telephone | 430-288-5800
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Fax | 800-797-3780
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Authorized Official
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Title or Position | CFO
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Name | ANTONIO LEJAUN BRIGHAM
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Credential |
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Telephone | 430-288-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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