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General NPI Number Information
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NPI Number | 1184535064
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Entity Type | Organization
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Legal Business Name | HEADWATERS MENTAL HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 690 S HWY 89 STE 201
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City | JACKSON
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State | WY
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Zip | 83001-8508
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Country | US
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Telephone | 307-264-0628
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1243
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City | JACKSON
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State | WY
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Zip | 83001-1243
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Country | US
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Telephone | 307-264-0628
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVE GRINNELL BARNETT
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Credential | PMHNP
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Telephone | 503-505-1468
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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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