Provider Demographics
NPI:1669195202
Name:INTELLECT PSYCHIATRY SERVICES PLLC
Entity type:Organization
Organization Name:INTELLECT PSYCHIATRY SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ETIENNE
Authorized Official - Middle Name:CLEMENT
Authorized Official - Last Name:POUFONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-321-9543
Mailing Address - Street 1:708 CLEMENT DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-7352
Mailing Address - Country:US
Mailing Address - Phone:469-321-9543
Mailing Address - Fax:682-227-2030
Practice Address - Street 1:6505 216TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2089
Practice Address - Country:US
Practice Address - Phone:469-321-9543
Practice Address - Fax:682-227-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)