Adom Telepsychiatry and Mental Health Services a Professional Nur

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ADOM TELEPSYCHIATRY AND MENTAL HEALTH SERVICES A PROFESSIONAL NUR

Practice address

4199 Flat Rock Dr Ste 148
Riverside, CA 92505-7115

Phone

(951) 707-7471

NPI assigned

Jan 29, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gladys Obeng, DNP,BSN, RN, PMHNP-B

Title

DNP

Phone

(951) 707-7471

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1003407388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77331",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928770111",
            "telephone_number": "951-254-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 FLAT ROCK DR STE 148",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925057115",
            "telephone_number": "951-707-7471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8350 Archibald Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917303670",
            "country_code": "US",
            "telephone_number": "951-254-3558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADOM TELEPSYCHIATRY AND MENTAL HEALTH SERVICES A PROFESSIONAL NUR",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-29",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "OBENG",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_title_or_position": "DNP",
        "authorized_official_telephone_number": "951-707-7471",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP,BSN, RN, PMHNP-B"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Riverside, CA
• Providers in Riverside, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.