Watershed Wellness Collective LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WATERSHED WELLNESS COLLECTIVE LLC

Practice address

412 Gallatin Pike S
Madison, TN 37115-4009

Phone

(310) 266-5044

NPI assigned

Apr 30, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melisse Prusinski, LMFT

Title

Owner/Provider

Phone

(310) 266-5044

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melisse Tokic, LMFT

  • Marriage & Family Therapist
  • Nashville, TN
  • NPI 1619367810
  NPD
• Frances Lee Hathorn

  • Mental Health Counselor
  • Madison, TN
  • NPI 1841114055
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1033966940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 TUCKAHOE DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372071640",
            "telephone_number": "310-266-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 GALLATIN PIKE S",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371154009",
            "telephone_number": "310-266-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED WELLNESS COLLECTIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "PRUSINSKI",
        "authorized_official_first_name": "MELISSE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "310-266-5044",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane C Walsh, AU.D.
• Kaitlin Elizabeth Walsh
• Stephen Walter, RPH
• Ashley Amber Ward, MSN, AGPCNP-BC
• Spencer Garrett Warren, DDS
• Benjamin Eric Watlington, CRNA
• Dennis I. Watts, DDS
• Matthew Waznis
• We Care Too Home Care Services
• We Care Too Home Care Services

• Mental Health Clinic/Center (Including Community Mental Health Center) in Madison, TN
• Providers in Madison, TN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.