Provider Demographics
NPI:1871192823
Name:OASIS TELEPSYCHIATRY, L.L.C.
Entity type:Organization
Organization Name:OASIS TELEPSYCHIATRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, ARNP, PMHNP-BC
Authorized Official - Phone:928-599-8785
Mailing Address - Street 1:1712 PIONEER AVE STE 1658
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4406
Mailing Address - Country:US
Mailing Address - Phone:928-599-8785
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE # FLOORS12
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2569
Practice Address - Country:US
Practice Address - Phone:928-599-8785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty