Provider Demographics
NPI:1487496212
Name:KINGSTAR BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:KINGSTAR BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FUNMILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINRIMISI
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, RN
Authorized Official - Phone:281-536-3843
Mailing Address - Street 1:2006 THOMPSON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4947
Mailing Address - Country:US
Mailing Address - Phone:832-692-2503
Mailing Address - Fax:346-239-1773
Practice Address - Street 1:2006 THOMPSON RD STE 204
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4947
Practice Address - Country:US
Practice Address - Phone:832-692-2503
Practice Address - Fax:346-239-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285497404Medicaid
TX1184281560Medicaid