Provider Demographics
NPI:1194471904
Name:MAYA BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MAYA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:MAYA
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHCNP, FNP, WHCNP
Authorized Official - Phone:469-363-1940
Mailing Address - Street 1:5407 LOWRIE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:469-363-1941
Mailing Address - Fax:
Practice Address - Street 1:350 WESTPARK WAY STE 223
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3758
Practice Address - Country:US
Practice Address - Phone:817-283-4438
Practice Address - Fax:817-283-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty