Healthcare Provider Details

I. General information

NPI: 1437420809
Provider Name (Legal Business Name): WHOLE ELDER MENTAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 WALTHAM ST NO. 120
LEXINGTON MA
02421-7934
US

IV. Provider business mailing address

405 WALTHAM ST NO. 120
LEXINGTON MA
02421-7934
US

V. Phone/Fax

Practice location:
  • Phone: 781-499-9075
  • Fax: 888-909-4776
Mailing address:
  • Phone: 781-499-9075
  • Fax: 888-909-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN205547
License Number StateMA

VIII. Authorized Official

Name: MISS KATHLEEN J OLSEN
Title or Position: OWNER
Credential: RN/NP
Phone: 781-999-0759