Provider Demographics
NPI:1811602535
Name:ESSENTIAL BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:ESSENTIAL BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:MUTIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBADE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:484-784-7379
Mailing Address - Street 1:935 E LANCASTER AVE # 1011
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3328
Mailing Address - Country:US
Mailing Address - Phone:484-784-7379
Mailing Address - Fax:
Practice Address - Street 1:709 N 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3108
Practice Address - Country:US
Practice Address - Phone:484-784-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty