Provider Demographics
NPI:1184451692
Name:SOUTHLAKE SERENITY PSYCHIATRY
Entity type:Organization
Organization Name:SOUTHLAKE SERENITY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEEMULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-203-3721
Mailing Address - Street 1:305 MIRON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 MIRON DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7831
Practice Address - Country:US
Practice Address - Phone:817-203-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty