Provider Demographics
NPI:1942922703
Name:TEXAS MIND BEHAVIOR AND PSYCHIATRIC CLINIC LLC
Entity Type:Organization
Organization Name:TEXAS MIND BEHAVIOR AND PSYCHIATRIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NP
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:EHIGIE
Authorized Official - Last Name:ESENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-407-1172
Mailing Address - Street 1:1301 E DEBBIE LN # 2305
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3305
Mailing Address - Country:US
Mailing Address - Phone:469-407-1172
Mailing Address - Fax:
Practice Address - Street 1:1301 E DEBBIE LN # 2305
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3305
Practice Address - Country:US
Practice Address - Phone:469-407-1172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty