NPIMap

Organization Active NPI

Two Trails Mental Health and Wellness Center, LLC

  • Psychologist
  • Mount Pleasant Mills, PA
National Provider Identifier
1376902486
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS016911 Issued in PA
Legal business name
TWO TRAILS MENTAL HEALTH AND WELLNESS CENTER, LLC
Practice address
8638 Route 104
Suite 10
Mount Pleasant Mills, PA 17853-8752
Phone
(717) 856-0220
Fax
(717) 685-3242
NPI assigned
Feb 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Dr. Danielle Marie Mink, PSY.D.NPI 1376588475
Title
President
Phone
(717) 856-0220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X PS016911 PA Primary

Addresses

Primary practice location

8638 Route 104
Suite 10
Mount Pleasant Mills, PA 17853-8752

Mailing address

560 Kellerville Rd
MC Alisterville, PA 17049-8580
Phone (717) 856-0220

Other identifiers 1

IdentifierTypeStateIssuer
293713OtherPACMS PTAN

Other names 1

  • Dr. Danielle M. Mink Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160324000903 PA Part B Supplier - Clinic/Group Practice 0345547097 Receives reassigned benefits from 2 practitioners
Practice locations: Richfield, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1376902486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 KELLERVILLE RD",
            "city": "MC ALISTERVILLE",
            "state": "PA",
            "postal_code": "170498580",
            "telephone_number": "717-856-0220",
            "fax_number": "717-685-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8638 ROUTE 104",
            "address_2": "SUITE 10",
            "city": "MOUNT PLEASANT MILLS",
            "state": "PA",
            "postal_code": "178538752",
            "telephone_number": "717-856-0220",
            "fax_number": "717-685-3242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWO TRAILS MENTAL HEALTH AND WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "MINK",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-856-0220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS PTAN",
            "identifier": "293713",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Danielle M. Mink",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant Mills, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.