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General NPI Number Information
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NPI Number | 1154160604
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Entity Type | Organization
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Legal Business Name | STATE OF MIND
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 411 S 12TH AVE STE 2
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City | YAKIMA
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State | WA
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Zip | 98902-3109
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Country | US
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Telephone | 509-969-3908
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Fax | 509-873-7188
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Provider Business Mailing Address
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Address Line | 11202 COTTONWOOD CANYON RD
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City | YAKIMA
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State | WA
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Zip | 98908-9372
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Country | US
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Telephone | 509-969-3908
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Fax | 509-873-7188
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | JAMES KENDALL EAKIN
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Credential | DNP, ARNP, PMHNP-BC
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Telephone | 509-969-3908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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