Provider Demographics
NPI:1023762440
Name:ADVANCED MENTAL HEALTH ALIMATOU MOUSTAPHA PLLC
Entity type:Organization
Organization Name:ADVANCED MENTAL HEALTH ALIMATOU MOUSTAPHA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:ALIMATOU
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSTAPHA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:206-683-0540
Mailing Address - Street 1:11318 BRIDGEPORT WAY SW STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3054
Mailing Address - Country:US
Mailing Address - Phone:206-683-0540
Mailing Address - Fax:
Practice Address - Street 1:11318 BRIDGEPORT WAY SW STE A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3054
Practice Address - Country:US
Practice Address - Phone:206-683-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty