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General NPI Number Information
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NPI Number | 1104610658
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Entity Type | Organization
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Legal Business Name | CLOVERHOPE MENTAL HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 32020 1ST AVE S STE 113
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5743
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Country | US
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Telephone | 253-600-4965
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Fax | 253-600-4960
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Provider Business Mailing Address
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Address Line | 32020 1ST AVE S STE 113
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5743
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NP- OWNER
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Name | DR. AGNES ANDAL MARAMBA
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Credential | NP
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Telephone | 253-600-4965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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