Provider Demographics
NPI:1417524489
Name:PHOENIX MINDS LLC
Entity Type:Organization
Organization Name:PHOENIX MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANU
Authorized Official - Middle Name:ATINUKE
Authorized Official - Last Name:OGUNYOKU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCH NP
Authorized Official - Phone:713-581-7961
Mailing Address - Street 1:25807 WESTHEIMER PKWY STE 422
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5369
Mailing Address - Country:US
Mailing Address - Phone:713-581-7961
Mailing Address - Fax:
Practice Address - Street 1:25807 WESTHEIMER PKWY STE 422
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5369
Practice Address - Country:US
Practice Address - Phone:713-581-7961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty