Provider Demographics
NPI:1962271429
Name:MYNDFULL CARE MANAGEMENT TEXAS PA
Entity type:Organization
Organization Name:MYNDFULL CARE MANAGEMENT TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-839-8878
Mailing Address - Street 1:9436 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 5 PMB 1113
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134
Mailing Address - Country:US
Mailing Address - Phone:855-839-8878
Mailing Address - Fax:
Practice Address - Street 1:1751 RIVER RUN
Practice Address - Street 2:OFFICE NO. 244
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:855-839-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty