Provider Demographics
NPI:1063303501
Name:PROFESSIONAL MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PROFESSIONAL MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:GHEREZGHIHER
Authorized Official - Last Name:ASGHEDOM
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:703-568-5059
Mailing Address - Street 1:172 THOMAS JOHNSON DR STE 203L2
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4402
Mailing Address - Country:US
Mailing Address - Phone:703-568-5059
Mailing Address - Fax:
Practice Address - Street 1:172 THOMAS JOHNSON DR STE 203L2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4402
Practice Address - Country:US
Practice Address - Phone:703-568-5059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-12
Last Update Date:2025-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty