Organization
ELITE PSYCHIATRY PC
Active
Organization
ELITE PSYCHIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVEN MODISETTE FNP-C, PMHNP-BC (CEO)
(817) 695-5035
Entity
Organization
Contact information
Practice address
3901 ARLINGTON HIGHLANDS BLVD STE 200, ARLINGTON, TX 76018-6050
(817) 695-5035
(817) 695-5037
Mailing address
3901 ARLINGTON HIGHLANDS BLVD STE 200, ARLINGTON, TX 76018-6050
(817) 695-5035
(817) 695-5037
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
M9770
TX
2084P0800X
Psychiatry Physician
Primary
M9770
TX
2084P0802X
Addiction Psychiatry Physician
M9770
TX
2084P0804X
Child & Adolescent Psychiatry Physician
M9770
TX
261QM0850X
Adult Mental Health Clinic/Center
M9770
TX
261QM0855X
Adolescent and Children Mental Health Clinic/Center
M9770
TX
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
AP137299
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
AP137299
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP137299
TEXAS BOARD OF NURSING
TX
Enumeration date
07/24/2018
Last updated
04/04/2020
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