Provider Demographics
NPI:1649739236
Name:INNOVATIVE PSYCH SOLUTIONS
Entity Type:Organization
Organization Name:INNOVATIVE PSYCH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP, APRN (CO-OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-917-3821
Mailing Address - Street 1:619 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3853
Mailing Address - Country:US
Mailing Address - Phone:817-917-3821
Mailing Address - Fax:
Practice Address - Street 1:1402 S CUSTER RD STE 202
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-1452
Practice Address - Country:US
Practice Address - Phone:214-842-8463
Practice Address - Fax:469-535-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235389685Medicaid
TX1750667101Medicaid