Provider Demographics
NPI:1639937709
Name:OPTIMUM MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:OPTIMUM MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & PSYCHIATRIC NURSE PRACTI
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:OMOTOSHO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:443-858-3189
Mailing Address - Street 1:10701 CHAPELDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133
Mailing Address - Country:US
Mailing Address - Phone:443-858-3189
Mailing Address - Fax:410-655-3484
Practice Address - Street 1:10701 CHAPELDALE ROAD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133
Practice Address - Country:US
Practice Address - Phone:443-858-3189
Practice Address - Fax:410-655-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty