MEDICARE: EFFULGENCE MENTAL & BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1215708045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EFFULGENCE MENTAL & BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2905 DUSTYWOOD DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6783
Country	:	US
Telephone Number	:	972-900-3652
Fax Number	:	877-306-2754

Provider Business Practice Location Address
First Line	:	9500 MEDICAL CENTER DR STE 270
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-3709
Country	:	US
Telephone Number	:	877-306-2758
Fax Number	:	877-306-2754

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IFEOMA IROKWE
Credential	:	PMHNP
Telephone Number	:	972-900-3652

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	02/14/2024

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