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General NPI Number Information
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NPI Number | 1346073814
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Entity Type | Organization
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Legal Business Name | PROSPERA MHW INC.
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 3249 MARLENE DR
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City | LAFAYETTE
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State | CA
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Zip | 94549-4723
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Country | US
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Telephone | 415-407-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 CONTRA COSTA BLVD # 1155
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City | PLEASANT HILL
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State | CA
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Zip | 94523-3742
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Country | US
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Telephone | 415-407-0988
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ANDREA NICOLE NILES
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Credential | PHD
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Telephone | 415-407-0988
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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