Provider Demographics
NPI:1568011880
Name:ADVANCED ACTION MENTAL HEALTH NP, A PROFESSIONAL NURSING CORPORATION
Entity Type:Organization
Organization Name:ADVANCED ACTION MENTAL HEALTH NP, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:AA MENTAL HEALTH AND WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-814-0084
Mailing Address - Street 1:12340 SEAL BEACH BLVD STE B187
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2792
Mailing Address - Country:US
Mailing Address - Phone:504-814-0084
Mailing Address - Fax:310-300-1814
Practice Address - Street 1:12340 SEAL BEACH BLVD STE B187
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2792
Practice Address - Country:US
Practice Address - Phone:504-814-0084
Practice Address - Fax:310-300-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty