| Psych Md Pllc | |
|
4425 Plano Pkwy Ste 1401 Carrollton TX 75010-5036 | |
| (214) 888-7711 | |
| Not Available |
| Full Name | Psych Md Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4425 Plano Pkwy Ste 1401, Carrollton, Texas |
| Authorized Official Name and Position | Djillali Boudjenah (CEO) |
| Authorized Official Contact | 9173368422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Md Pllc Po Box 867443 Plano TX 75086-7443 Ph: (214) 888-7711 | Psych Md Pllc 4425 Plano Pkwy Ste 1401 Carrollton TX 75010-5036 Ph: (214) 888-7711 |
| NPI Number | 1609240977 |
|---|---|
| Provider Enumeration Date | 11/24/2015 |
| Last Update Date | 03/16/2023 |
| Certification Date | 03/16/2023 |
| Medicare PECOS PAC ID | 4587953807 |
|---|---|
| Medicare Enrollment ID | O20160510000880 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609240977 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Djillali Boudjenah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083724256 PECOS PAC ID: 6901906544 Enrollment ID: I20130709000313 |
| Provider Name | Rhoda Madamombe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477131415 PECOS PAC ID: 5193129641 Enrollment ID: I20210806000023 |
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