Provider Demographics
NPI:1962185769
Name:CRYSTAL MIND PSYCHIATRY AND COUNSELING
Entity type:Organization
Organization Name:CRYSTAL MIND PSYCHIATRY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOYE-ADELUSI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-265-4770
Mailing Address - Street 1:1107 FOXTAIL DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2325
Mailing Address - Country:US
Mailing Address - Phone:347-265-4770
Mailing Address - Fax:
Practice Address - Street 1:307 S MCDONALD ST STE 500
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-5625
Practice Address - Country:US
Practice Address - Phone:469-461-7286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty