Provider Demographics
NPI:1609690197
Name:NORTHWIND HOLISTIC PSYCHIATRY PLLC
Entity type:Organization
Organization Name:NORTHWIND HOLISTIC PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-984-7174
Mailing Address - Street 1:212 WASHINGTON ST STE F
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9173
Mailing Address - Country:US
Mailing Address - Phone:320-500-2024
Mailing Address - Fax:320-244-7958
Practice Address - Street 1:212 WASHINGTON ST STE F
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9173
Practice Address - Country:US
Practice Address - Phone:320-500-2024
Practice Address - Fax:320-244-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty