MEDICARE: KINGSTAR BEHAVIORAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251B00000X	Case Management Agency
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487496212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSTAR BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	2006 THOMPSON RD STE 204
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4947
Country	:	US
Telephone Number	:	832-692-2503
Fax Number	:	346-239-1773

Provider Business Practice Location Address
First Line	:	2006 THOMPSON RD STE 204
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4947
Country	:	US
Telephone Number	:	832-692-2503
Fax Number	:	346-239-1773

Authorized Official
Title or Position	:	MANAGER
Name	:	FUNMILAYO AKINRIMISI
Credential	:	CNP, RN
Telephone Number	:	281-536-3843

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “KINGSTAR BEHAVIORAL HEALTH PLLC ” Practice Location

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