Provider Demographics
NPI:1760250070
Name:ALLEGORY MENTAL HEALTH ADVANCED PRACTICE PSYCHIATRIC NURSING PC
Entity Type:Organization
Organization Name:ALLEGORY MENTAL HEALTH ADVANCED PRACTICE PSYCHIATRIC NURSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:209-840-0235
Mailing Address - Street 1:250 S OAK AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3572
Mailing Address - Country:US
Mailing Address - Phone:209-840-0235
Mailing Address - Fax:
Practice Address - Street 1:250 S OAK AVE STE A2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3572
Practice Address - Country:US
Practice Address - Phone:209-840-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty