Provider Demographics
NPI:1720718364
Name:STABLE MIND THERAPY
Entity Type:Organization
Organization Name:STABLE MIND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIJUWADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGOJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-863-8200
Mailing Address - Street 1:18514 PROVIDENCE LANDING LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1201
Mailing Address - Country:US
Mailing Address - Phone:832-863-8200
Mailing Address - Fax:
Practice Address - Street 1:2012 E HIGHWAY
Practice Address - Street 2:9OA
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406
Practice Address - Country:US
Practice Address - Phone:832-535-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty