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PRESTIGE MENTAL HEALTH PLLC

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Company Details

Legal Name: PRESTIGE MENTAL HEALTH PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: October 22nd 2022
Expiration date: 31 Oct 2025
UBI Number: 604 986 167
ZIP code: 98391
City: Bonney Lake
County: PIERCE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 7720 190TH AVE E, BONNEY LAKE, WA, 98391-7010, UNITED STATES

Contact Details

E-Mail: PRESTIGEMENTALHEALTHSERVICES@GMAIL.COM
Phone Number: +1 253-293-0683

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
MILLICENT MBUA Registered Agent 7720 190TH AVE E, BONNEY LAKE, WA, 98391-7010, UNITED STATES

Key Officers & Management

Name Role Address
MILLICENT MBUA Executor 7720 190TH AVE E, BONNEY LAKE, WA, 98391-7010, UNITED STATES
MILLICENT MBUA Governing Person 7720 190TH AVE E, BONNEY LAKE, WA, 98391-7010, UNITED STATES

National Provider Identifier

NPI Number:
1881452571
Certification Date:
2024-03-07

Authorized Person:

Name:
MILLICENT MBUA
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2533974640
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