Complete Wellness Behavioral Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

COMPLETE WELLNESS BEHAVIORAL HEALTH LLC

Practice address

7112 Sandown Cir Apt 303
Windsor Mill, MD 21244-7928

Phone

(240) 643-5232

NPI assigned

Aug 5, 2021

Organization subpart

No

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

Authorized official

Name

Eselle Mathias Molua, PMHNP

Title

Ceo

Phone

(240) 643-5232

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1104590785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7112 SANDOWN CIR APT 303",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212447928",
            "telephone_number": "240-643-5232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7112 SANDOWN CIR APT 303",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212447928",
            "telephone_number": "240-643-5232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE WELLNESS BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "MOLUA",
        "authorized_official_first_name": "ESELLE",
        "authorized_official_middle_name": "MATHIAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-643-5232",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "WindsorMill",
            "affiliation": "N",
            "endpointDescription": "Address",
            "address_1": "7112 Sandown Cir Apt 303",
            "city": "Windsor Mill",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212447928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Windsor Mill, MD
• Providers in Windsor Mill, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.