Affect Provider Group, P.S.C.
Social Worker, Clinical in Tyler, TX. Organization (NPI-2).
NPI number1043147549
StatusActive
Last updated in NPPESAug 13, 2026
Details
- NPI
- 1043147549
- Entity type
- Organization (NPI-2)
- Legal business name
- Affect Provider Group, P.S.C.
- Organization subpart
- No
- Enumeration date
- May 7, 2026
- Certification date
- Aug 13, 2026
- Last updated
- Aug 13, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
| 101Y00000X | Counselor | – | – | |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 101YP2500X | Counselor, Professional | – | – | |
| 106H00000X | Marriage & Family Therapist | – | – | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – |
Practice location
3800 Paluxy Dr Ste 404Tyler, TX 75703-1617
Phone 845-769-8758
Mailing address
Po Box 96635Phoenix, AZ 85072-6635
Phone 845-769-8758
Authorized official
Karl Renee Mullings
Director Of Compliance
9516919101
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