Provider Demographics
NPI:1982351029
Name:ALL-MERCY PSYCHIATRY AND INTEGRATIVE CARE LLC
Entity Type:Organization
Organization Name:ALL-MERCY PSYCHIATRY AND INTEGRATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGEUSANG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-605-4672
Mailing Address - Street 1:5440 TUXBURY POND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1489
Mailing Address - Country:US
Mailing Address - Phone:240-605-4672
Mailing Address - Fax:
Practice Address - Street 1:5440 TUXBURY POND DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1489
Practice Address - Country:US
Practice Address - Phone:240-605-4672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty