Bluehaven Psychiatry PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BLUEHAVEN PSYCHIATRY PLLC

Practice address

3960 Broadway Blvd Ste 140
Garland, TX 75043-2593

Phone

(316) 516-4972

NPI assigned

Oct 9, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ngomeni M Mbilikira, PMHNPNPI 1578251070

Title

Ceo

Phone

(214) 432-1669

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, KS, OK, NM4 enrollments

Enrollment records 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ngomeni M Mbilikira, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Garland, TX
  • NPI 1578251070

  KS, OK

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1215718184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 W FM 544 UNIT 625",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750983330",
            "telephone_number": "214-432-1669",
            "fax_number": "214-416-7823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 BROADWAY BLVD STE 140",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750432593",
            "telephone_number": "316-516-4972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEHAVEN PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-09",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "MBILIKIRA",
        "authorized_official_first_name": "NGOMENI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-432-1669",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Bledsoe, M.S., CCC-SLP
• Katalin Bloemer
• Monique Angele Blondel, MD
• Jamila Aisha Blount, FNP-C
• Sharhonda Blue, PA-C
• Blueprints at Room for Change PLLC
• Carmen Blunt, DDS
• Bodavula Pediatrics PLLC
• Phani Bodavula, M.D.
• Sreevani Bodavula, APRN, FNP-C

• Psychiatry Physician in Garland, TX
• Providers in Garland, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.