Provider Demographics
NPI:1760221865
Name:ACACIA MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ACACIA MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:N
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:214-475-0883
Mailing Address - Street 1:4607 S BOWDISH HIGH CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-9427
Mailing Address - Country:US
Mailing Address - Phone:214-475-0883
Mailing Address - Fax:509-517-6485
Practice Address - Street 1:522 W RIVERSIDE AVE STE 5668
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:509-227-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty