Provider Demographics
NPI:1790399863
Name:EZ MIND PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:EZ MIND PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-868-6944
Mailing Address - Street 1:3751 MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4138
Mailing Address - Country:US
Mailing Address - Phone:972-632-6040
Mailing Address - Fax:
Practice Address - Street 1:2770 MAIN ST STE 119
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4336
Practice Address - Country:US
Practice Address - Phone:972-632-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty