Provider Demographics
NPI:1629769609
Name:LULLABIES TEENTALK AND ADULT PSYCHIATRIC WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LULLABIES TEENTALK AND ADULT PSYCHIATRIC WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLAYEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ONONOGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-662-4823
Mailing Address - Street 1:1903 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7039
Mailing Address - Country:US
Mailing Address - Phone:817-662-4823
Mailing Address - Fax:
Practice Address - Street 1:1701 W NORTHWEST HWY STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8145
Practice Address - Country:US
Practice Address - Phone:817-662-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty