Provider Demographics
NPI:1740949361
Name:PSYCHIATRIC GUIDANCE LLC
Entity type:Organization
Organization Name:PSYCHIATRIC GUIDANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:FARIDY
Authorized Official - Middle Name:MAYA
Authorized Official - Last Name:MOMBELEUR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-445-6366
Mailing Address - Street 1:7820B WORKMANS MILL RD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:469-445-6366
Mailing Address - Fax:
Practice Address - Street 1:145 WILLOWDALE DR APT 34
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-1168
Practice Address - Country:US
Practice Address - Phone:469-445-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty