Provider Demographics
NPI:1437754579
Name:MENTAL HEALTH THERAPEUTIC INNOVATION
Entity Type:Organization
Organization Name:MENTAL HEALTH THERAPEUTIC INNOVATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-210-8800
Mailing Address - Street 1:PO BOX 4149
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01101-4149
Mailing Address - Country:US
Mailing Address - Phone:413-210-8800
Mailing Address - Fax:413-317-7100
Practice Address - Street 1:191 CHESTNUT ST STE 2C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1512
Practice Address - Country:US
Practice Address - Phone:413-210-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty