Provider Demographics
NPI:1134880958
Name:ITEINJOH, PROMISE A (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PROMISE
Middle Name:A
Last Name:ITEINJOH
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 GUILD MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7681
Mailing Address - Country:US
Mailing Address - Phone:713-291-8567
Mailing Address - Fax:
Practice Address - Street 1:250 S TOOLE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1814
Practice Address - Country:US
Practice Address - Phone:520-323-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX828393163W00000X
AZ273608363LP0808X
IAG167616363LP0808X
TX1259529363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse