Provider Demographics
NPI:1134466410
Name:WELL MIND LLC
Entity Type:Organization
Organization Name:WELL MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESKY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:808-896-4121
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:HAKALAU
Mailing Address - State:HI
Mailing Address - Zip Code:96710-0173
Mailing Address - Country:US
Mailing Address - Phone:808-896-4121
Mailing Address - Fax:
Practice Address - Street 1:120 KEAWE ST
Practice Address - Street 2:STE 203B
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2874
Practice Address - Country:US
Practice Address - Phone:808-896-4121
Practice Address - Fax:808-963-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty