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General NPI Number Information
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NPI Number | 1558034892
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Entity Type | Organization
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Legal Business Name | OPTIMAL MENTAL HEALTH VIRTUAL CLINIC, PLLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 1430 GADSDEN HWY STE 116-618
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3103
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Country | US
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Telephone | 205-775-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 GADSDEN HWY STE 116-618
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3103
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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 | CEO
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Name | DR. SUMMYJI GROOM
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Credential | DNP, PMHNP-BC
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Telephone | 205-775-0080
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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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