Healthcare Provider Details

I. General information

NPI: 1063041671
Provider Name (Legal Business Name): HYGGE BEHAVIORAL HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 NEWARK GRANVILLE RD
GRANVILLE OH
43023-1436
US

IV. Provider business mailing address

594 NEWARK GRANVILLE RD
GRANVILLE OH
43023-1436
US

V. Phone/Fax

Practice location:
  • Phone: 740-618-2322
  • Fax: 740-618-2324
Mailing address:
  • Phone: 740-618-2322
  • Fax: 740-618-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STACEY ANTLE
Title or Position: OWNER
Credential: APRN-CNP
Phone: 740-618-2322