Provider Demographics
NPI:1699463455
Name:OPTIMAL PSYCHIATRY CLINIC LLC
Entity type:Organization
Organization Name:OPTIMAL PSYCHIATRY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-259-9867
Mailing Address - Street 1:21 BISHOP CUTOFF
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:NH
Mailing Address - Zip Code:03585-6902
Mailing Address - Country:US
Mailing Address - Phone:832-259-9867
Mailing Address - Fax:
Practice Address - Street 1:21 BISHOP CUTOFF
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:NH
Practice Address - Zip Code:03585-6902
Practice Address - Country:US
Practice Address - Phone:832-259-9867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty