Provider Demographics
NPI:1659100667
Name:UDUMA BEHAVIORAL HEALTH SERVICES PLCC
Entity type:Organization
Organization Name:UDUMA BEHAVIORAL HEALTH SERVICES PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:UDUMA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:903-521-4984
Mailing Address - Street 1:2212 DOVER LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5822
Mailing Address - Country:US
Mailing Address - Phone:903-521-4984
Mailing Address - Fax:
Practice Address - Street 1:2212 DOVER LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5822
Practice Address - Country:US
Practice Address - Phone:903-521-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty