Provider Demographics
NPI:1568118800
Name:HEALTHY SELF MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:HEALTHY SELF MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGENTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:850-879-1164
Mailing Address - Street 1:8759 GREENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3696
Mailing Address - Country:US
Mailing Address - Phone:850-879-1164
Mailing Address - Fax:
Practice Address - Street 1:1010 CAPITAL CIRCLE SW
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-9261
Practice Address - Country:US
Practice Address - Phone:850-879-1164
Practice Address - Fax:850-848-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health