Provider Demographics
NPI:1942911417
Name:TEAM MENTATION PLLC
Entity Type:Organization
Organization Name:TEAM MENTATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:MR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:276-248-1880
Mailing Address - Street 1:11708 NICKELSVILLE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NICKELSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24271-2872
Mailing Address - Country:US
Mailing Address - Phone:276-248-1880
Mailing Address - Fax:276-258-0616
Practice Address - Street 1:11708 NICKELSVILLE HWY STE 200
Practice Address - Street 2:
Practice Address - City:NICKELSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24271-2872
Practice Address - Country:US
Practice Address - Phone:276-248-1880
Practice Address - Fax:276-258-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty