Provider Demographics
NPI:1528815230
Name:DIVINE PSYCHIATRIC FOUNDATION PLLC
Entity type:Organization
Organization Name:DIVINE PSYCHIATRIC FOUNDATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKODILI
Authorized Official - Middle Name:O
Authorized Official - Last Name:OJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-362-5697
Mailing Address - Street 1:1415 NORTH LOOP W STE 300-14
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1664
Mailing Address - Country:US
Mailing Address - Phone:347-668-9857
Mailing Address - Fax:
Practice Address - Street 1:1415 NORTH LOOP W STE 300-14
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1664
Practice Address - Country:US
Practice Address - Phone:832-362-5697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty