Provider Demographics
NPI:1295152148
Name:AMICABLE PSYCHIATRY MD, PA
Entity type:Organization
Organization Name:AMICABLE PSYCHIATRY MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOTAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ONANUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-771-0191
Mailing Address - Street 1:PO BOX 2043
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-2043
Mailing Address - Country:US
Mailing Address - Phone:817-778-0191
Mailing Address - Fax:817-421-2940
Practice Address - Street 1:833 E NORTHWEST HWY STE 400
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3302
Practice Address - Country:US
Practice Address - Phone:817-778-0191
Practice Address - Fax:817-421-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty