| Courageous Minds Llc | |
|
160 Keonekai Rd Apt 27-206 Kihei HI 96753-7145 | |
| (808) 666-1442 | |
| (808) 666-1442 |
| Full Name | Courageous Minds Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 160 Keonekai Rd Apt 27-206, Kihei, Hawaii |
| Authorized Official Name and Position | Roger Johnston (OWNER) |
| Authorized Official Contact | 8086661442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Courageous Minds Llc 160 Keonekai Rd Apt 27-206 Kihei HI 96753-7145 Ph: (808) 666-1442 | Courageous Minds Llc 160 Keonekai Rd Apt 27-206 Kihei HI 96753-7145 Ph: (808) 666-1442 |
| NPI Number | 1437838125 |
|---|---|
| Provider Enumeration Date | 07/12/2023 |
| Last Update Date | 07/12/2023 |
| Certification Date | 07/12/2023 |
| Medicare PECOS PAC ID | 7214384809 |
|---|---|
| Medicare Enrollment ID | O20231102003389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437838125 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Roger Dale Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750718979 PECOS PAC ID: 8123475712 Enrollment ID: I20231102003427 |
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