Provider Demographics
NPI:1629830344
Name:KMB MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:KMB MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIJIC-BARISIC
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:216-924-8879
Mailing Address - Street 1:278 CEDAR LN SE # 4104
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6613
Mailing Address - Country:US
Mailing Address - Phone:703-278-3767
Mailing Address - Fax:
Practice Address - Street 1:278 CEDAR LN SE # 4104
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6613
Practice Address - Country:US
Practice Address - Phone:703-278-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty