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General NPI Number Information
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NPI Number | 1093454423
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Entity Type | Organization
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Legal Business Name | OPEN MIND MENTAL HEALTH PHYSICIANS, INC.
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 438 CAMINO DEL RIO S STE 106
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City | SAN DIEGO
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State | CA
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Zip | 92108-3546
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Country | US
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Telephone | 855-550-6463
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1429
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City | SALISBURY
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State | NC
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Zip | 28145-1429
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Country | US
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Telephone | 206-724-1722
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Fax | 833-453-0569
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Authorized Official
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Title or Position | COO
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Name | MR. KERRY DUANE KOZUKI
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Credential |
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Telephone | 206-724-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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