Provider Demographics
NPI:1700647120
Name:SERENITY PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRY PLLC
Other - Org Name:SERENITY PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEDAMOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEFIOYE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:862-250-1834
Mailing Address - Street 1:23207 MULBERRY THICKET TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3877
Mailing Address - Country:US
Mailing Address - Phone:862-250-1834
Mailing Address - Fax:
Practice Address - Street 1:24044 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8432
Practice Address - Country:US
Practice Address - Phone:862-250-1834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-23
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
TX1099238OtherBOARD OF NURSING