MEDICARE: VIVIQUE PSYCHIATRY PLLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1346012036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVIQUE PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	16325 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1233
Country	:	US
Telephone Number	:	210-975-7505
Fax Number	:	361-288-3247

Provider Business Practice Location Address
First Line	:	16325 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1233
Country	:	US
Telephone Number	:	210-975-7505
Fax Number	:	361-288-3247

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	VIVIAN NGOZI ELEGE
Credential	:
Telephone Number	:	713-820-3543

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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