Provider Demographics
NPI:1053419747
Name:MENTAL HEALTH RESOURCES LLC
Entity type:Organization
Organization Name:MENTAL HEALTH RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELIKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-617-0510
Mailing Address - Street 1:125 HEMLOCK POINT DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-2336
Mailing Address - Country:US
Mailing Address - Phone:860-617-0510
Mailing Address - Fax:
Practice Address - Street 1:125 HEMLOCK POINT DR
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-2336
Practice Address - Country:US
Practice Address - Phone:860-617-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003094363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400003094CT03OtherANTHEM BCBS
CT400003094CT03OtherANTHEM BCBS