Provider Demographics
NPI:1124626114
Name:ALAMO PREMIER MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:ALAMO PREMIER MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOLADE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-929-3034
Mailing Address - Street 1:8546 BROADWAY STE 135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6354
Mailing Address - Country:US
Mailing Address - Phone:210-940-2764
Mailing Address - Fax:830-239-9930
Practice Address - Street 1:8546 BROADWAY STE 135
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6354
Practice Address - Country:US
Practice Address - Phone:210-940-2764
Practice Address - Fax:830-239-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty