Provider Demographics
NPI:1518551126
Name:WELL MIND PERINATAL, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:WELL MIND PERINATAL, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATAYUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAENI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, PMH-C
Authorized Official - Phone:909-451-9951
Mailing Address - Street 1:2058 N MILLS AVE # 516
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 N INDIAN HILL BLVD STE C1-200
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4667
Practice Address - Country:US
Practice Address - Phone:909-451-9951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)