Healthcare Provider Details

I. General information

NPI: 1194326959
Provider Name (Legal Business Name): PRESENCE OF MIND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1942 7TH AVE.
KEAAU HI
96749
US

IV. Provider business mailing address

15-2662 PAHOA VILLAGE RD N306 PMB 8592
PAHOA HI
96778
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-3636
  • Fax: 808-731-5048
Mailing address:
  • Phone: 206-992-3636
  • Fax: 808-731-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZOEY LYNN FAUGHT
Title or Position: CEO
Credential: LMHC
Phone: 206-992-3636