| Ikare Mood Trauma Recovery Clinic | |
|
8401 Datapoint Dr Ste 900 San Antonio TX 78229-5385 | |
| (210) 301-0125 | |
| (844) 965-9528 |
| Full Name | Ikare Mood Trauma Recovery Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8401 Datapoint Dr Ste 900, San Antonio, Texas |
| Authorized Official Name and Position | Ravindra Shah (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 2672108357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ikare Mood Trauma Recovery Clinic 8401 Datapoint Dr Ste 900 San Antonio TX 78229-5385 Ph: (210) 301-0125 | Ikare Mood Trauma Recovery Clinic 8401 Datapoint Dr Ste 900 San Antonio TX 78229-5385 Ph: (210) 301-0125 |
| NPI Number | 1003361635 |
|---|---|
| Provider Enumeration Date | 08/24/2016 |
| Last Update Date | 05/05/2021 |
| Certification Date | 05/05/2021 |
| Medicare PECOS PAC ID | 1355622051 |
|---|---|
| Medicare Enrollment ID | O20170111000124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003361635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | Q4829 (Texas) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | AP129429 (Texas) | Secondary |
| Provider Name | Maxim S Eckmann |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1457470312 PECOS PAC ID: 8628132883 Enrollment ID: I20090203000196 |
| Provider Name | Marlon P Quinones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700083797 PECOS PAC ID: 7911172671 Enrollment ID: I20111207000484 |
| Provider Name | Stephen Check |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154703569 PECOS PAC ID: 8527378058 Enrollment ID: I20151112000700 |
| Provider Name | Olumayowa Omoyeni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356847529 PECOS PAC ID: 7618224841 Enrollment ID: I20180719001609 |
| Provider Name | Cathrine Owiye Odim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750628020 PECOS PAC ID: 1355528472 Enrollment ID: I20190503001438 |
| Provider Name | Ciddet Ricardo Abrahams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740742501 PECOS PAC ID: 9133556608 Enrollment ID: I20200221001270 |
| Provider Name | Lannie Larose Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831730027 PECOS PAC ID: 3173922887 Enrollment ID: I20210601000969 |
| Provider Name | Christina Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679183800 PECOS PAC ID: 3072914688 Enrollment ID: I20210701003623 |
| Provider Name | Mojisola Nwofor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760157622 PECOS PAC ID: 6901298116 Enrollment ID: I20220120002411 |
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