Provider Demographics
NPI:1689313082
Name:PALM OUTPATIENT MENTAL HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:PALM OUTPATIENT MENTAL HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC APN
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOTOLA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DANMOLE-ODIMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:217-553-0266
Mailing Address - Street 1:7011 PRESTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-4310
Mailing Address - Country:US
Mailing Address - Phone:217-553-0266
Mailing Address - Fax:
Practice Address - Street 1:7011 PRESTON DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-4310
Practice Address - Country:US
Practice Address - Phone:217-553-0266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care