Provider Demographics
NPI:1659162691
Name:PURE POTENTIAL MENTAL HEALTHCARE
Entity type:Organization
Organization Name:PURE POTENTIAL MENTAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOORES KRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:415-278-1574
Mailing Address - Street 1:1417 12TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3334
Mailing Address - Country:US
Mailing Address - Phone:415-278-1574
Mailing Address - Fax:
Practice Address - Street 1:1735 E FORT LOWELL RD STE 5
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2358
Practice Address - Country:US
Practice Address - Phone:520-230-5262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)