# MIKKADESH MENTAL HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mikkadesh Mental Healthcare LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063120020
- **Authorized official:** VERONICA ABEH FORCHU (PRESIDENT/ADMINISTRATOR)
- **Authorized official phone:** (801) 649-7584

## Contact information

- **Practice address:** 12923 EMERALD RIDGE BLVD E, PUYALLUP, WA 98374-8403
- **Practice address phone:** (801) 649-7584
- **Mailing address:** 12923 EMERALD RIDGE BLVD E, PUYALLUP, WA 98374-8403
- **Mailing address phone:** (801) 649-7584

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2022
- **Last updated:** 12/10/2024