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General NPI Number Information
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NPI Number | 1568118800
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Entity Type | Organization
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Legal Business Name | HEALTHY SELF MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1010 CAPITAL CIRCLE SW
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City | TALLAHASSEE
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State | FL
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Zip | 32304-9261
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Country | US
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Telephone | 850-879-1164
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Fax | 850-848-6543
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Provider Business Mailing Address
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Address Line | 8759 GREENRIDGE LN
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3696
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Country | US
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Telephone | 850-879-1164
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Fax |
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | DR. MAGENTA HALL
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Credential | MSN, APRN
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Telephone | 850-879-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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