MEDICARE: LAKERIDGE 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1871435867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKERIDGE PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	669 AIRPORT FWY STE 401
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-3964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	669 AIRPORT FWY STE 401
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-3964
Country	:	US
Telephone Number	:	972-332-5922
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JONAS BEYENE
Credential	:	MD
Telephone Number	:	972-332-5922

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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