Provider Demographics
NPI:1790430809
Name:MENTAL HEALTH SAVAGE LLC
Entity type:Organization
Organization Name:MENTAL HEALTH SAVAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATAMILORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODIMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MA
Authorized Official - Phone:305-896-0729
Mailing Address - Street 1:7011 PRESTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-4310
Mailing Address - Country:US
Mailing Address - Phone:305-896-0729
Mailing Address - Fax:
Practice Address - Street 1:2151 W WHITE OAKS DR STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6410
Practice Address - Country:US
Practice Address - Phone:305-896-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty