Provider Demographics
NPI:1821975558
Name:MENTIS PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:MENTIS PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-C
Authorized Official - Prefix:DR
Authorized Official - First Name:IVY
Authorized Official - Middle Name:KONADU
Authorized Official - Last Name:ATTOBRA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:301-213-2471
Mailing Address - Street 1:4539 N 22ND ST STE N
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4639
Mailing Address - Country:US
Mailing Address - Phone:301-213-2471
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE N
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4639
Practice Address - Country:US
Practice Address - Phone:301-213-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)