Provider Demographics
NPI:1124837794
Name:RISING SUN MENTAL HEALTH PC
Entity type:Organization
Organization Name:RISING SUN MENTAL HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LIBUSER
Authorized Official - Last Name:SATYUKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:310-351-4503
Mailing Address - Street 1:4742 N 24TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9107
Mailing Address - Country:US
Mailing Address - Phone:623-703-9308
Mailing Address - Fax:
Practice Address - Street 1:400 CORPORATE POINTE STE 300
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7620
Practice Address - Country:US
Practice Address - Phone:310-351-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty