Provider Demographics
NPI:1386871796
Name:DELTA OAK MENTAL HEALTH PC
Entity type:Organization
Organization Name:DELTA OAK MENTAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA
Authorized Official - Phone:425-212-9255
Mailing Address - Street 1:3307 RUCKER AVE
Mailing Address - Street 2:C/O MCPARTNERS, INC.
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4226
Mailing Address - Country:US
Mailing Address - Phone:425-212-9255
Mailing Address - Fax:425-212-9302
Practice Address - Street 1:1540 38TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6712
Practice Address - Country:US
Practice Address - Phone:425-212-9255
Practice Address - Fax:425-212-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit