Provider Demographics
NPI:1619748878
Name:ALLY MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ALLY MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:440-622-3728
Mailing Address - Street 1:7541 MENTOR AVE STE A103
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5431
Mailing Address - Country:US
Mailing Address - Phone:440-457-1112
Mailing Address - Fax:440-457-1112
Practice Address - Street 1:7541 MENTOR AVE
Practice Address - Street 2:SUITES A103 & A104
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5431
Practice Address - Country:US
Practice Address - Phone:440-622-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty