Provider Demographics
NPI:1982389318
Name:MENTAL HEALTH WELLNESS LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:808-940-5757
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1114
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4406
Mailing Address - Country:US
Mailing Address - Phone:808-940-5757
Mailing Address - Fax:
Practice Address - Street 1:185 S KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1523
Practice Address - Country:US
Practice Address - Phone:808-940-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty