Organization Active NPI

East Texas Psychiatry and Counseling PLLC

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Tyler, TX
National Provider Identifier
1962201855
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X
Legal business name
EAST TEXAS PSYCHIATRY AND COUNSELING PLLC
Practice address
100 Independence PL Ste 307
Tyler, TX 75703-1328
Phone
(430) 288-5800
Fax
(800) 797-3780
NPI assigned
Mar 12, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Authorized official

Name
Antonio Lejaun BrighamNPI 1801492889
Title
Cfo
Phone
(430) 288-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 364SP0808X Primary

Addresses

Primary practice location

100 Independence PL Ste 307
Tyler, TX 75703-1328

Mailing address

100 Independence PL Ste 307
Tyler, TX 75703-1328
Phone (430) 288-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250819004100 TX Part B Supplier - Clinic/Group Practice 3173022795 Receives reassigned benefits from 4 practitioners
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

100 Independence Pl
Ste 307
Tyler, TX 75703
Phone (214) 326-8795

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1741737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1962201855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 INDEPENDENCE PL STE 307",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031328",
            "telephone_number": "430-288-5800",
            "fax_number": "800-797-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 INDEPENDENCE PL STE 307",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031328",
            "telephone_number": "430-288-5800",
            "fax_number": "800-797-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PSYCHIATRY AND COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-12",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A",
        "authorized_official_last_name": "BRIGHAM",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "LEJAUN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "430-288-5800"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.