Provider Demographics
NPI:1306420013
Name:CENTERED YOUTH CLINIC AND CONSULTING PLLC
Entity Type:Organization
Organization Name:CENTERED YOUTH CLINIC AND CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER, MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:
Authorized Official - Last Name:EFURIBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:860-983-6542
Mailing Address - Street 1:20617 FAIRLEAF ST
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14008 SHADOWGLEN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3406
Practice Address - Country:US
Practice Address - Phone:512-842-9655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251S00000XAgenciesCommunity/Behavioral Health