Provider Demographics
NPI:1922860303
Name:PASSPORT MENTAL HEALTH JOURNEY
Entity Type:Organization
Organization Name:PASSPORT MENTAL HEALTH JOURNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, APRN, PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUBOLA
Authorized Official - Middle Name:OMOLARA
Authorized Official - Last Name:SALABIU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:763-308-5080
Mailing Address - Street 1:1380 84TH LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1443
Mailing Address - Country:US
Mailing Address - Phone:763-308-3080
Mailing Address - Fax:
Practice Address - Street 1:1380 84TH LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1443
Practice Address - Country:US
Practice Address - Phone:763-308-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty