MEDICARE: CENTER FOR INTEGRATIVE PSYCHIATRY

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	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1902532591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR INTEGRATIVE PSYCHIATRY

Provider Business Mailing Address
First Line	:	580 S DENTON TAP RD STE 280
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4073
Country	:	US
Telephone Number	:	917-287-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 S DENTON TAP RD STE 280
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4073
Country	:	US
Telephone Number	:	917-287-8207
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAHIR N KHWAJA
Credential	:	MD
Telephone Number	:	917-287-8207

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	02/02/2026

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