Open Mind Wellness

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC-5123 Issued in ID

Legal business name

OPEN MIND WELLNESS

Practice address

5920 N Government Way
#4
Dalton Gardens, ID 83815-9200

Phone

(208) 819-0550

NPI assigned

Jun 5, 2015

Last updated

Jun 5, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Daniel Garcia, LPC

Title

Owner

Phone

(208) 819-0550

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1699155457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 N GOVERNMENT WAY",
            "address_2": "#4",
            "city": "DALTON GARDENS",
            "state": "ID",
            "postal_code": "838159200",
            "telephone_number": "208-819-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 N GOVERNMENT WAY",
            "address_2": "#4",
            "city": "DALTON GARDENS",
            "state": "ID",
            "postal_code": "838159200",
            "telephone_number": "208-819-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN MIND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-819-0550",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ID",
            "license": "LPC-5123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Dalton Gardens, ID
• Providers in Dalton Gardens, ID by specialty
• Community/Behavioral Health Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.