Healthy Mind Behavioral Health Clinic LLC

Primary specialty

Child & Family Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0810X

Legal business name

HEALTHY MIND BEHAVIORAL HEALTH CLINIC LLC

Practice address

9492 W Fairview Ave
Boise, ID 83704-8101

Phone

(208) 284-7100

Fax

(208) 213-3659

NPI assigned

Sep 25, 2023

Organization subpart

No

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

Authorized official

Name

Christopher Munga Gakwa, NPNPI 1205355831

Title

Pmhnp

Phone

(208) 284-7100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 2

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

• Christopher Munga Gakwa

  • Psychiatric/Mental Health Nurse Practitioner
  • Boise, ID
  • NPI 1205355831
  Medicare reassignment Care Compare group NPD Authorized official
• Gyoice Abatey

  • Psychiatric/Mental Health Nurse Practitioner
  • Nampa, ID
  • NPI 1174319750
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1710766159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9492 W FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048101",
            "telephone_number": "208-284-7100",
            "fax_number": "208-213-3659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9492 W FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048101",
            "telephone_number": "208-284-7100",
            "fax_number": "208-213-3659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY MIND BEHAVIORAL HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "GAKWA",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "MUNGA",
        "authorized_official_title_or_position": "PMHNP",
        "authorized_official_telephone_number": "208-284-7100",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "364SP0810X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Nurse Specialist in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Nurse Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.