Provider Demographics
NPI:1790377711
Name:ADVANCED PRACTICE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:ADVANCED PRACTICE MENTAL HEALTH, LLC
Other - Org Name:ADVANCED PRACTICE HEALTH ASSOCIATES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, CAQ PSYCH,LCSW
Authorized Official - Phone:405-833-1108
Mailing Address - Street 1:3409 STONE BROOK CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-0812
Mailing Address - Country:US
Mailing Address - Phone:405-627-2830
Mailing Address - Fax:
Practice Address - Street 1:1932 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1202
Practice Address - Country:US
Practice Address - Phone:405-627-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty