MEDICARE: THE PUPPY WATER ENTERTAINMENT FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251300000X	Local Education Agency (LEA)
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811454218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PUPPY WATER ENTERTAINMENT FOUNDATION

Provider Business Mailing Address
First Line	:	609 DEEP VALLEY DR STE 200-057
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3629
Country	:	US
Telephone Number	:	424-279-3898
Fax Number	:	949-695-3114

Provider Business Practice Location Address
First Line	:	609 DEEP VALLEY DR # 200057
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3629
Country	:	US
Telephone Number	:	424-279-3898
Fax Number	:	949-695-3114

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRINCESS OKIEME
Credential	:	LCSW
Telephone Number	:	424-279-3898

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	05/04/2024

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Directions to “THE PUPPY WATER ENTERTAINMENT FOUNDATION ” Practice Location

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