Provider Demographics
NPI:1265252555
Name:EMEX BEHAVORAL HEALTH CLINIC
Entity type:Organization
Organization Name:EMEX BEHAVORAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP- BC
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUKITIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-218-6302
Mailing Address - Street 1:410 NW 11TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5416
Mailing Address - Country:US
Mailing Address - Phone:214-218-6302
Mailing Address - Fax:
Practice Address - Street 1:410 NW 11TH ST STE 107
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5416
Practice Address - Country:US
Practice Address - Phone:214-218-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty