Provider Demographics
NPI:1124593199
Name:KUPONYA TELEPSYCHIATRY, LLC
Entity Type:Organization
Organization Name:KUPONYA TELEPSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOFFRAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:888-909-6409
Mailing Address - Street 1:2500 WILCREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2754
Mailing Address - Country:US
Mailing Address - Phone:888-909-6409
Mailing Address - Fax:364-888-5268
Practice Address - Street 1:2500 WILCREST DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2754
Practice Address - Country:US
Practice Address - Phone:888-909-6409
Practice Address - Fax:364-888-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty