Provider Demographics
NPI:1437716909
Name:ADVANCED PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ADVANCED PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-873-0590
Mailing Address - Street 1:1100 E SOUTHLAKE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6350
Mailing Address - Country:US
Mailing Address - Phone:817-873-0590
Mailing Address - Fax:817-873-0591
Practice Address - Street 1:1100 E SOUTHLAKE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6350
Practice Address - Country:US
Practice Address - Phone:817-873-0590
Practice Address - Fax:817-873-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty