Provider Demographics
NPI:1295444321
Name:MY MENTAL HEALTH MATTERS PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:MY MENTAL HEALTH MATTERS PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FORTUNATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNHUTU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-PMHNP-BC
Authorized Official - Phone:978-457-1194
Mailing Address - Street 1:400 TRADECENTER STE 5900
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7471
Mailing Address - Country:US
Mailing Address - Phone:617-468-1115
Mailing Address - Fax:
Practice Address - Street 1:400 TRADECENTER STE 5900
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7471
Practice Address - Country:US
Practice Address - Phone:617-468-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2307110OtherLICENSE