Provider Demographics
NPI:1174242911
Name:AMENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:AMENTAL HEALTH, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-689-1706
Mailing Address - Street 1:11802 TRAILWOOD PL NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8618
Mailing Address - Country:US
Mailing Address - Phone:360-689-1706
Mailing Address - Fax:
Practice Address - Street 1:555 ANDOVER PARK W STE 205
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3379
Practice Address - Country:US
Practice Address - Phone:206-395-4744
Practice Address - Fax:360-282-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty