Provider Demographics
NPI:1861144032
Name:BAOBAB PSYCHIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:BAOBAB PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KOMI
Authorized Official - Middle Name:AFANGNON
Authorized Official - Last Name:KOKOU-ABI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP-BC
Authorized Official - Phone:865-306-8847
Mailing Address - Street 1:2200 N A W GRIMES BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2745
Mailing Address - Country:US
Mailing Address - Phone:512-655-3104
Mailing Address - Fax:833-955-3628
Practice Address - Street 1:2200 N A W GRIMES BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2745
Practice Address - Country:US
Practice Address - Phone:512-655-3104
Practice Address - Fax:833-955-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty