=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518604669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN-TUITT BEHAVIORAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2022
-----------------------------------------------------
Last Update Date | 05/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 LOWER WESTFIELD RD STE 101&203
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-9403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-222-6284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 273 NAISMITH ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01104-3749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-222-6284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC MENTAL HELTH NP
-----------------------------------------------------
Name | DR. KHADIJA TUITT
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 413-222-6284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------