Provider Demographics
NPI:1598598997
Name:AQ MENTAL HEALTH MANAGEMENT LLC
Entity type:Organization
Organization Name:AQ MENTAL HEALTH MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AKTSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:214-516-3615
Mailing Address - Street 1:327 NE 5TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2030
Mailing Address - Country:US
Mailing Address - Phone:214-516-4627
Mailing Address - Fax:
Practice Address - Street 1:327 NE 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2030
Practice Address - Country:US
Practice Address - Phone:214-516-4627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty