Provider Demographics
NPI:1295108348
Name:ATEJ PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:ATEJ PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ONOJETA
Authorized Official - Middle Name:
Authorized Official - Last Name:OHWEVWO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:316-281-5114
Mailing Address - Street 1:5901 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2517
Mailing Address - Country:US
Mailing Address - Phone:316-281-5114
Mailing Address - Fax:763-271-2707
Practice Address - Street 1:5901 BROOKLYN BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55429-2517
Practice Address - Country:US
Practice Address - Phone:316-281-5114
Practice Address - Fax:763-271-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2179612364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty