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General NPI Number Information
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NPI Number | 1194528091
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Entity Type | Organization
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Legal Business Name | PRIME MENTAL HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 211 STOCKSDALE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-5507
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Country | US
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Telephone | 380-285-1288
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Fax | 937-806-4104
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Provider Business Mailing Address
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Address Line | 16685 RAINTREE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-7062
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Country | US
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Telephone | 380-285-1288
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Fax | 937-806-4104
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Authorized Official
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Title or Position | PSYCHIATRIC MENTAL HEALTH NP
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Name | MATTHEW HAUENSTEIN
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 380-285-1288
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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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