Provider Demographics
NPI:1700483468
Name:KND BEHAVIORAL HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:KND BEHAVIORAL HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUBUYA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:661-472-4897
Mailing Address - Street 1:99 REGENCY PKWY STE 113
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7818
Mailing Address - Country:US
Mailing Address - Phone:972-904-5760
Mailing Address - Fax:817-592-3323
Practice Address - Street 1:99 REGENCY PKWY STE 113
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7818
Practice Address - Country:US
Practice Address - Phone:972-904-5760
Practice Address - Fax:817-592-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4177644Medicaid
TX417764401Medicaid