Provider Demographics
NPI:1366207904
Name:SERENITY BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:SERENITY BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:NDUTA
Authorized Official - Last Name:NDUATI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:770-572-2098
Mailing Address - Street 1:4801 176TH ST E APT K308
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-2847
Mailing Address - Country:US
Mailing Address - Phone:770-572-2098
Mailing Address - Fax:
Practice Address - Street 1:4801 176TH ST E APT K308
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-2847
Practice Address - Country:US
Practice Address - Phone:770-572-2098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health