Provider Demographics
NPI:1962020859
Name:MATCH HEALTHCARE CONSULTING
Entity Type:Organization
Organization Name:MATCH HEALTHCARE CONSULTING
Other - Org Name:TELEPSYCHIATRIC LOUNGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKEM AKWIWU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:404-547-3893
Mailing Address - Street 1:3995 BONNETT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-6205
Mailing Address - Country:US
Mailing Address - Phone:470-594-2570
Mailing Address - Fax:
Practice Address - Street 1:6505 216TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TER
Practice Address - State:WA
Practice Address - Zip Code:98043-2089
Practice Address - Country:US
Practice Address - Phone:470-594-2570
Practice Address - Fax:470-275-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)