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NPI Code Detail

MEDICARE: MAMA TOUT PUISSANT

MEDICARE: MAMA TOUT PUISSANT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902294176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAMA TOUT PUISSANT
Provider Business Mailing Address
First Line : 4158 SW DARIEN ST
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34953-6107
Country : US
Telephone Number : 954-681-5424
Fax Number :
Provider Business Practice Location Address
First Line : 63311 JAMISON ST
Second Line :
City : BEND
State : OR
Zip : 97703-8288
Country : US
Telephone Number : 541-322-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2014
Last Update Date : 05/30/2024

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Directions to “ MAMA TOUT PUISSANT ” Practice Location

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