MEDICARE: BAOBAB PSYCHIATRIC SERVICES, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1861144032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAOBAB PSYCHIATRIC SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2200 N A W GRIMES BLVD STE 600
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2745
Country	:	US
Telephone Number	:	512-655-3104
Fax Number	:	833-955-3628

Provider Business Practice Location Address
First Line	:	2200 N A W GRIMES BLVD STE 600
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2745
Country	:	US
Telephone Number	:	512-655-3104
Fax Number	:	833-955-3628

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. KOMI AFANGNON KOKOU-ABI
Credential	:	DNP PMHNP-BC
Telephone Number	:	865-306-8847

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	03/18/2025

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