Provider Demographics
NPI:1184482523
Name:GIDEXFDA PSYCHIATRY AND BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:GIDEXFDA PSYCHIATRY AND BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:NNABUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-457-5529
Mailing Address - Street 1:2717 COMMERCIAL CENTER BLVD STE E200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2717 COMMERCIAL CENTER BLVD STE E200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7823
Practice Address - Country:US
Practice Address - Phone:832-457-5529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty