| Healthy Self Mental Wellness Llc | |
|
1010 Capital Circle Sw Tallahassee FL 32304-9261 | |
| (850) 879-1164 | |
| (850) 848-6543 |
| Full Name | Healthy Self Mental Wellness Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1010 Capital Circle Sw, Tallahassee, Florida |
| Authorized Official Name and Position | Magenta Hall (OWNER OF ENTITY) |
| Authorized Official Contact | 8508791164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Self Mental Wellness Llc 8759 Greenridge Ln Tallahassee FL 32312-3696 Ph: (850) 879-1164 | Healthy Self Mental Wellness Llc 1010 Capital Circle Sw Tallahassee FL 32304-9261 Ph: (850) 879-1164 |
| NPI Number | 1568118800 |
|---|---|
| Provider Enumeration Date | 02/24/2022 |
| Last Update Date | 12/30/2022 |
| Certification Date | 12/29/2022 |
| Medicare PECOS PAC ID | 9032597521 |
|---|---|
| Medicare Enrollment ID | O20220613001957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568118800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Magenta Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518465582 PECOS PAC ID: 8123379948 Enrollment ID: I20180918002678 |
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