Provider Demographics
NPI:1700592524
Name:TRIPPLE J MENTAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:TRIPPLE J MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSADEBAMWEN
Authorized Official - Middle Name:LIZZY
Authorized Official - Last Name:OMOREGIE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:425-529-3814
Mailing Address - Street 1:451 SW 10TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2981
Mailing Address - Country:US
Mailing Address - Phone:425-529-3814
Mailing Address - Fax:
Practice Address - Street 1:451 SW 10TH ST STE 202
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2981
Practice Address - Country:US
Practice Address - Phone:425-529-3814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty