MEDICARE: MED MENTAL 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	:	1477375061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	6237 HIGHWAY 6 S STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1681
Country	:	US
Telephone Number	:	346-220-3534
Fax Number	:

Provider Business Practice Location Address
First Line	:	6237 HIGHWAY 6 S STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1681
Country	:	US
Telephone Number	:	346-220-3534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH YISA
Credential	:
Telephone Number	:	407-749-0934

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	10/25/2024

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Directions to “MED MENTAL HEALTH LLC ” Practice Location

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