Provider Demographics
NPI:1437420809
Name:WHOLE ELDER MENTAL HEALTH INC.
Entity Type:Organization
Organization Name:WHOLE ELDER MENTAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN/NP
Authorized Official - Phone:781-999-0759
Mailing Address - Street 1:405 WALTHAM ST
Mailing Address - Street 2:NO. 120
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7934
Mailing Address - Country:US
Mailing Address - Phone:781-499-9075
Mailing Address - Fax:888-909-4776
Practice Address - Street 1:405 WALTHAM ST
Practice Address - Street 2:NO. 120
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7934
Practice Address - Country:US
Practice Address - Phone:781-499-9075
Practice Address - Fax:888-909-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN205547163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty