MEDICARE: GROWTHFAIRNESS 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1659198224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTHFAIRNESS PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	12337 JONES RD STE 330
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4951
Country	:	US
Telephone Number	:	832-449-6276
Fax Number	:	713-554-1811

Provider Business Practice Location Address
First Line	:	12337 JONES RD STE 330
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4951
Country	:	US
Telephone Number	:	832-449-6276
Fax Number	:	713-554-1811

Authorized Official
Title or Position	:	CEO
Name	:	RAYMOND C OBIAJULU
Credential	:
Telephone Number	:	832-449-6276

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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