Provider Demographics
NPI:1639882913
Name:LOGICAL MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:LOGICAL MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:I
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-C
Authorized Official - Phone:206-250-7034
Mailing Address - Street 1:4301 S PINE ST STE 30-12
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-9123
Mailing Address - Country:US
Mailing Address - Phone:206-765-0592
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 30-12
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-9123
Practice Address - Country:US
Practice Address - Phone:206-765-0592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty