Provider Demographics
NPI:1528395563
Name:MENTIS
Entity Type:Organization
Organization Name:MENTIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-255-0966
Mailing Address - Street 1:709 FRANKLIN ST.
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2920
Mailing Address - Country:US
Mailing Address - Phone:707-255-0966
Mailing Address - Fax:707-255-3110
Practice Address - Street 1:3260 BEARD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3423
Practice Address - Country:US
Practice Address - Phone:707-255-0966
Practice Address - Fax:707-255-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health