1285411199 NPI number — JUST THIS MOMENT MINDFUL PSYCHOTHERAPY PLLC

Table of content: (NPI 1285411199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285411199 NPI number — JUST THIS MOMENT MINDFUL PSYCHOTHERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUST THIS MOMENT MINDFUL PSYCHOTHERAPY PLLC
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:
1285411199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 DICKENS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50665-2034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-883-1144
Provider Business Mailing Address Fax Number:
319-472-0024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 DICKENS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50665-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-883-1144
Provider Business Practice Location Address Fax Number:
319-472-0024
Provider Enumeration Date:
09/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
OZBOURNE NIGRO
Authorized Official First Name:
CANZADIE
Authorized Official Middle Name:
AUTUMN
Authorized Official Title or Position:
OWNER/CLINICIAN
Authorized Official Telephone Number:
319-883-1144

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0058230 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com