Provider Demographics
NPI:1134656747
Name:DENNIS GATES, MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:DENNIS GATES, MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:GATES
Authorized Official - Suffix:II
Authorized Official - Credentials:FPMHNP-BC
Authorized Official - Phone:301-955-9812
Mailing Address - Street 1:9500 ARENA DR
Mailing Address - Street 2:SUITE 432
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3701
Mailing Address - Country:US
Mailing Address - Phone:301-955-9812
Mailing Address - Fax:301-955-9813
Practice Address - Street 1:9500 ARENA DR
Practice Address - Street 2:SUITE 432
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3701
Practice Address - Country:US
Practice Address - Phone:301-955-9812
Practice Address - Fax:301-955-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207808103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty