1164284501 NPI number — HEAL OUT LOUD LLC

Table of content: DR. ANDRE POTHEL DESIRE MD (NPI 1568427714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164284501 NPI number — HEAL OUT LOUD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAL OUT LOUD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164284501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2515 BANKSVILLE RD # 1134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15216-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-999-5378
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 VALOIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15205-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-999-5378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
DEAH
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
411-999-5378

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)