Provider Demographics
NPI:1972105005
Name:CROSSESSENCE MENTAL HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:CROSSESSENCE MENTAL HEALTHCARE GROUP, LLC
Other - Org Name:CROSSESSENCE MENTAL HEALTHCARE GROUP, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:FUNMILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINRIMISI
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:281-536-3843
Mailing Address - Street 1:2006 THOMPSON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4947
Mailing Address - Country:US
Mailing Address - Phone:281-239-3155
Mailing Address - Fax:800-824-9930
Practice Address - Street 1:2006 THOMPSON RD STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4947
Practice Address - Country:US
Practice Address - Phone:281-239-3155
Practice Address - Fax:800-824-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184281560Medicaid