Organization
ELITE PSYCHIATRY PC
Active
Other names
Elite Psychiatry PC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RAVEN ELLIOTT MODISETTE FNP-C, PMHNP-BC (C.E.O)
(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
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
M9770
TX
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP137299
APRN LICENSE NUMBER
TX
01
—
M9770
TX MEDICAL BOARD
TX
Enumeration date
07/20/2018
Last updated
05/16/2020
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