Provider Demographics
NPI:1942959176
Name:SUVEKCHYA SUBEDI, PLLC
Entity Type:Organization
Organization Name:SUVEKCHYA SUBEDI, PLLC
Other - Org Name:CONNECT, HEAL AND EMPOWER PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:HOLLINGSWORTH
Authorized Official - Last Name:SOJOURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-721-2372
Mailing Address - Street 1:2629 WALKER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-2027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2629 WALKER CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-2027
Practice Address - Country:US
Practice Address - Phone:817-962-9063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health