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General NPI Number Information
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NPI Number | 1962779660
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Entity Type | Organization
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Legal Business Name | SERENDIPITY WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 1732 GALLERIA OAKS DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4649
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Country | US
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Telephone | 903-794-1636
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Fax | 903-793-1746
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Provider Business Mailing Address
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Address Line | 5411 PLAZA DR SUITE F
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City | TEXARKANA
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State | TX
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Zip | 75503-1666
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Country | US
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Telephone | 903-334-8140
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ROBERT C STRAYHAN
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Credential | M.D.
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Telephone | 903-280-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | J5027
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License Number State | TX
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