NPI | 1952888265 |
---|---|
Former Legal Business Name | ELITE PSYCHIATRY PC |
Entity Type | Organization |
Authorized Contact | RAVEN ELLIOTT MODISETTE C.E.O 817-695-5035 |
Organization Subpart ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX M9770) |
2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
363LF0000X Nurse Practitioner, Family | |
363LP0808X Nurse Practitioner, Psych/Mental Health | |
Enumeration Date | 2018-07-20 |
Last Update Date | 2020-05-16 |