Provider Demographics
NPI:1154109338
Name:PENIEL PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PENIEL PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:TEMILOLA
Authorized Official - Last Name:ADEDAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-521-3198
Mailing Address - Street 1:816 VIOLET WAY
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-1760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:816 VIOLET WAY
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-1760
Practice Address - Country:US
Practice Address - Phone:682-521-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty