Organization
EVIBRANT MENTAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEISHA MARSOLAN PMHNP-BC (OWNER/CEO)
(903) 452-0680
Entity
Organization
Contact information
Practice address
3122 NEALY WAY STE 201, LONGVIEW, TX 75605-1092
(903) 833-9875
Mailing address
1704 NORTHWOOD CT, LONGVIEW, TX 75605-2304
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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