Provider Demographics
NPI:1629616107
Name:MENTAL ESSENCE LLC
Entity Type:Organization
Organization Name:MENTAL ESSENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:OGUNSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:240-813-3814
Mailing Address - Street 1:13238 EXECUTIVE PARK TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2640
Mailing Address - Country:US
Mailing Address - Phone:240-813-3814
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:13238 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2640
Practice Address - Country:US
Practice Address - Phone:240-813-3814
Practice Address - Fax:301-260-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty