Provider Demographics
NPI:1972015022
Name:OASIS MIND AND BODY
Entity Type:Organization
Organization Name:OASIS MIND AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIAMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-612-9565
Mailing Address - Street 1:3301 PLAINVIEW
Mailing Address - Street 2:1
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504
Mailing Address - Country:US
Mailing Address - Phone:281-972-8870
Mailing Address - Fax:
Practice Address - Street 1:3301 PLAINVIEW
Practice Address - Street 2:1
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504
Practice Address - Country:US
Practice Address - Phone:281-972-8870
Practice Address - Fax:346-802-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
TX530639261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty