Provider Demographics
NPI:1013435262
Name:NORTHWINDS MAUI WELLNESS & RECOVERY INC.
Entity Type:Organization
Organization Name:NORTHWINDS MAUI WELLNESS & RECOVERY INC.
Other - Org Name:NORTHWINDS WELLTOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KATHLYN
Authorized Official - Last Name:GERHARD-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-865-8158
Mailing Address - Street 1:4954 BILOXI AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4813
Mailing Address - Country:US
Mailing Address - Phone:714-865-8158
Mailing Address - Fax:
Practice Address - Street 1:1711 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2106
Practice Address - Country:US
Practice Address - Phone:714-865-8158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT47701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty