Organization
MENS-SANA TELEPSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JYOTSNA MUTTINENI MD (OWNER)
(817) 292-4600
Entity
Organization
Contact information
Practice address
5560 MESA SPRINGS DR, FORT WORTH, TX 76123-2120
(817) 292-4600
Mailing address
PO BOX 93148, SOUTHLAKE, TX 76092-1148
(817) 292-4600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
P8392
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306106059
IND NPI
—
Enumeration date
08/16/2018
Last updated
08/16/2018
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