Provider Demographics
NPI:1154744266
Name:PUISSANT LLC DBA INTEGRATED MINDS
Entity type:Organization
Organization Name:PUISSANT LLC DBA INTEGRATED MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:YEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBOWALE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:832-419-3267
Mailing Address - Street 1:4107 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-329-7764
Mailing Address - Fax:956-329-7766
Practice Address - Street 1:4107 CROSSPOINT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-329-7764
Practice Address - Fax:956-329-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770332251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health