Active NPI
Tassiellimentalhealthandwellness LLC
- Psychiatric/Mental Health Nurse Practitioner
- Kettering, OH
National Provider Identifier
1316614829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- TASSIELLIMENTALHEALTHANDWELLNESS LLC
- Practice address
- 3085 Woodman Dr Ste 205
Kettering, OH 45420-1171 - Phone
- (937) 502-4567
- Fax
- (609) 293-0270
- NPI assigned
- Aug 24, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lidia Berrone, APRN, PMHNP-BC
- Title
- Owner
- Phone
- (937) 502-4567
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary | ||
| Acute Care Clinical Nurse Specialist | 364SA2100X |
Addresses
Primary practice location
3085 Woodman Dr Ste 205
Kettering, OH 45420-1171
Mailing address
3085 Woodman Dr Ste 205
Kettering, OH 45420-1171
Phone (937) 502-4567
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0458021 | Medicaid | OH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | tassiellimentalhealth@protonmail.com |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629763200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1632960000000",
"number": "1316614829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3085 WOODMAN DR STE 205",
"city": "KETTERING",
"state": "OH",
"postal_code": "454201171",
"telephone_number": "937-502-4567",
"fax_number": "609-293-0270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3085 WOODMAN DR STE 205",
"city": "KETTERING",
"state": "OH",
"postal_code": "454201171",
"telephone_number": "937-502-4567",
"fax_number": "609-293-0270"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TASSIELLIMENTALHEALTHANDWELLNESS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-24",
"last_updated": "2021-09-30",
"certification_date": "2021-09-30",
"status": "A",
"authorized_official_last_name": "BERRONE",
"authorized_official_first_name": "LIDIA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "937-502-4567",
"authorized_official_credential": "APRN, PMHNP-BC"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "364SA2100X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Clinical Nurse Specialist, Acute Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0458021",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "tassiellimentalhealth@protonmail.com",
"affiliation": "N",
"endpointDescription": "secured email",
"address_1": "3085 Woodman Dr Ste 205",
"city": "Kettering",
"state": "OH",
"country_code": "US",
"postal_code": "454201171",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.