Provider Demographics
NPI:1154061513
Name:ULTIMATE PROFESSIONAL MENTAL HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:ULTIMATE PROFESSIONAL MENTAL HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ANNABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:614-804-0866
Mailing Address - Street 1:748 MARKET ST # 135
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3737
Mailing Address - Country:US
Mailing Address - Phone:832-819-4378
Mailing Address - Fax:253-954-3116
Practice Address - Street 1:748 MARKET ST # 135
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3737
Practice Address - Country:US
Practice Address - Phone:832-819-4378
Practice Address - Fax:253-954-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty