Elite Psychiatry PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M9770 Issued in TX

Legal business name

ELITE PSYCHIATRY PC

Practice address

3901 Arlington Highlands Blvd Ste 200
Arlington, TX 76018-6050

Phone

(817) 695-5035

Fax

(817) 695-5037

NPI assigned

Jul 24, 2018

Organization subpart

No

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

Authorized official

Name

Raven Modisette, FNP-C, PMHNP-BCNPI 1225580293

Title

Ceo

Phone

(817) 695-5035

Specialties & licenses 11

Addresses

Other identifiers 1

Tax ID family

Elite Psychiatry PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elite Psychiatry PC

  • Psychiatry Physician
  • Arlington, TX
  • NPI 1952888265
  NPD tax ID

Practitioners 1

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

• Raven Modisette, FNP-C,PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Arlington, TX
  • NPI 1225580293
  NPD Authorized official

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585958400000",
    "number": "1770060691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186050",
            "telephone_number": "817-695-5035",
            "fax_number": "817-695-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186050",
            "telephone_number": "817-695-5035",
            "fax_number": "817-695-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PSYCHIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2020-04-04",
        "certification_date": "2020-04-04",
        "status": "A",
        "authorized_official_last_name": "MODISETTE",
        "authorized_official_first_name": "RAVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-695-5035",
        "authorized_official_credential": "FNP-C, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "TX",
            "license": "M9770",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "M9770",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "TX",
            "license": "M9770",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "M9770",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "TX",
            "license": "M9770",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "TX",
            "license": "M9770",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP137299",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP137299",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF NURSING",
            "identifier": "AP137299",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elevate Life Medical PLLC Dba Apex Integrative Health
• Elevation Health S. Arlington LLC
• Susan A Elias, PMHNP-BC
• Elise Maria LLC (Vitality Family Chiropractic)
• Elite Homecare Services, LLC
• Elite Psychiatry PC
• Elite Vision Center
• Elitecare Medical Equipment LLC
• Natalie Elizabeth Elizondo
• Dena Elkins, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.