Provider Demographics
NPI:1104610658
Name:CLOVERHOPE MENTAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:CLOVERHOPE MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:ANDAL
Authorized Official - Last Name:MARAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:253-600-4965
Mailing Address - Street 1:32020 1ST AVE S STE 113
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32020 1ST AVE S STE 113
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5743
Practice Address - Country:US
Practice Address - Phone:253-600-4965
Practice Address - Fax:253-600-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty