Organization
SUPPORTIVE MINDS PROFESSIONAL LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAFON FOMUJANG (CO-OWNER)
(405) 549-6290
Entity
Organization
Contact information
Practice address
23607 ORTENSIA ST, RICHMOND, TX 77406-1588
(405) 549-6290
Mailing address
23607 ORTENSIA ST, RICHMOND, TX 77406-1588
(405) 549-6290
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/06/2023
Last updated
06/06/2023
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