Provider Demographics
NPI:1417609645
Name:OWIMAST HEALTH LLC
Entity Type:Organization
Organization Name:OWIMAST HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-227-8651
Mailing Address - Street 1:210 RUDDER RUN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4306
Mailing Address - Country:US
Mailing Address - Phone:843-227-8651
Mailing Address - Fax:
Practice Address - Street 1:3458 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1485
Practice Address - Country:US
Practice Address - Phone:843-227-8651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty