Provider Demographics
NPI:1407639396
Name:HEALING LIGHT PSYCHIATRY
Entity Type:Organization
Organization Name:HEALING LIGHT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:JELILAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-619-7235
Mailing Address - Street 1:4131 N CENTRAL EXPY STE 900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4131 N CENTRAL EXPY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2120
Practice Address - Country:US
Practice Address - Phone:469-619-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty