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1134466410 NPI number — WELL MIND LLC

NPI Number: 1134466410
Health Care Provider/Practitioner: WELL MIND LLC

Information about “1134466410” NPI (WELL MIND LLC) exists in 1134466410 in HTML format HTML  |  1134466410 in plain Text format TXT  |  1134466410 in PDF (Portable Document Format) PDF  |  1134466410 in an XML format XML  formats.

NPI Number : 1134466410 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134466410",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WELL MIND LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 173",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAKALAU",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96710-0173",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-896-4121",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "120 KEAWE ST",
    "SecondLinePracticeLocationAddress": "STE 203B",
    "PracticeLocationAddressCityName": "HILO",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96720-2874",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-896-4121",
    "PracticeLocationAddressFaxNumber": "808-963-6016",
    "EnumerationDate": "01/07/2013",
    "LastUpdateDate": "01/07/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TRESKY",
    "AuthorizedOfficialFirstName": "SHARI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MA, LMHC",
    "AuthorizedOfficialTelephoneNumber": "808-896-4121",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "MHC292",
        "LicenseNumberStateCode": "HI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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