Provider Demographics
NPI:1225574023
Name:FAMILY MENTAL CLINIC LLC
Entity Type:Organization
Organization Name:FAMILY MENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:ABULSEOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-896-7664
Mailing Address - Street 1:5570 STERRETT PL
Mailing Address - Street 2:100
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2641
Mailing Address - Country:US
Mailing Address - Phone:443-896-7664
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL
Practice Address - Street 2:100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2641
Practice Address - Country:US
Practice Address - Phone:443-896-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health