Provider Demographics
NPI:1639862089
Name:WINDHAM PYSCHIATRY P.C.
Entity type:Organization
Organization Name:WINDHAM PYSCHIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:143-235-2976
Mailing Address - Street 1:2412 N GRANDVIEW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1631
Mailing Address - Country:US
Mailing Address - Phone:432-352-9767
Mailing Address - Fax:
Practice Address - Street 1:2412 N GRANDVIEW AVE STE 201
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1631
Practice Address - Country:US
Practice Address - Phone:432-352-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health