Provider Demographics
NPI:1457184715
Name:PROSPER FAMILY PSYCHIATRY
Entity type:Organization
Organization Name:PROSPER FAMILY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-582-1742
Mailing Address - Street 1:2870 SUNFISH ST
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3336
Mailing Address - Country:US
Mailing Address - Phone:516-582-1742
Mailing Address - Fax:
Practice Address - Street 1:291 S PRESTON RD STE 410
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1904
Practice Address - Country:US
Practice Address - Phone:214-620-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)