Provider Demographics
NPI:1790220291
Name:ULTIMATE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:ULTIMATE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GOSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANKWA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:614-804-0635
Mailing Address - Street 1:14135 SUNDIAL STONE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1100
Mailing Address - Country:US
Mailing Address - Phone:614-804-0635
Mailing Address - Fax:
Practice Address - Street 1:14135 SUNDIAL STONE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1100
Practice Address - Country:US
Practice Address - Phone:614-804-0635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132780363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty