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310 E Interstate 30 Ste B106 Garland TX 75043-4047 | |
| (469) 778-0263 | |
| (469) 778-0262 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 310 E Interstate 30 Ste B106, Garland, Texas |
| Authorized Official Name and Position | Jennipher Mann (OFFICE/BILLING MANAGER) |
| Authorized Official Contact | 4697780263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
310 E Interstate 30 Ste B106 Garland TX 75043-4047 Ph: (469) 778-0263 | 310 E Interstate 30 Ste B106 Garland TX 75043-4047 Ph: (469) 778-0263 |
| NPI Number | 1821755182 |
|---|---|
| Provider Enumeration Date | 11/22/2021 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 2365819471 |
|---|---|
| Medicare Enrollment ID | O20221102002283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821755182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Chima Nathaniel Asikaiwe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992003669 PECOS PAC ID: 2264722859 Enrollment ID: I20160901001984 |
| Provider Name | Cecilia Chanda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154904183 PECOS PAC ID: 7719375237 Enrollment ID: I20211102001015 |
| Provider Name | Tiera Hughes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659893501 PECOS PAC ID: 6507207347 Enrollment ID: I20240510002998 |
| Provider Name | Amy Baynash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447007299 PECOS PAC ID: 1850835034 Enrollment ID: I20240628000912 |
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