Provider Demographics
NPI:1639457641
Name:THE VICTORIOUS MIND PLLC
Entity Type:Organization
Organization Name:THE VICTORIOUS MIND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-441-9022
Mailing Address - Street 1:PO BOX 685042
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78768-5042
Mailing Address - Country:US
Mailing Address - Phone:806-441-9022
Mailing Address - Fax:
Practice Address - Street 1:103 12TH STREET
Practice Address - Street 2:STE 201
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3814
Practice Address - Country:US
Practice Address - Phone:806-441-9022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34808251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health