Provider Demographics
NPI:1407579303
Name:HEALTHY MIND LLC
Entity Type:Organization
Organization Name:HEALTHY MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-382-6816
Mailing Address - Street 1:PO BOX 2224
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-0224
Mailing Address - Country:US
Mailing Address - Phone:808-382-6816
Mailing Address - Fax:
Practice Address - Street 1:94-210 PUPUKAHI ST STE 207
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2649
Practice Address - Country:US
Practice Address - Phone:808-382-6816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIXXXXXXXXXXXXXXXXXXXXMedicaid