Provider Demographics
NPI:1215708045
Name:EFFULGENCE MENTAL & BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:EFFULGENCE MENTAL & BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:IROKWE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:972-900-3652
Mailing Address - Street 1:2905 DUSTYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6783
Mailing Address - Country:US
Mailing Address - Phone:972-900-3652
Mailing Address - Fax:877-306-2754
Practice Address - Street 1:9500 MEDICAL CENTER DR STE 270
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3709
Practice Address - Country:US
Practice Address - Phone:877-306-2758
Practice Address - Fax:877-306-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty