Provider Demographics
NPI:1164732335
Name:MENTAL HEALTH SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:HAROIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-318-9613
Mailing Address - Street 1:PO BOX 1744
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3744
Mailing Address - Country:US
Mailing Address - Phone:253-318-9613
Mailing Address - Fax:
Practice Address - Street 1:7512 STANICH LN
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5129
Practice Address - Country:US
Practice Address - Phone:253-318-9613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2382103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty