Provider Demographics
NPI:1033699343
Name:MENS-SANA TELEPSYCHIATRY PLLC
Entity type:Organization
Organization Name:MENS-SANA TELEPSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JYOTSNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTTINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-292-4600
Mailing Address - Street 1:PO BOX 93148
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1148
Mailing Address - Country:US
Mailing Address - Phone:817-292-4600
Mailing Address - Fax:
Practice Address - Street 1:5560 MESA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2120
Practice Address - Country:US
Practice Address - Phone:817-292-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP83922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306106059OtherIND NPI