Provider Demographics
NPI:1871356832
Name:COHERENT MINDS
Entity type:Organization
Organization Name:COHERENT MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIYAMBERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-381-6544
Mailing Address - Street 1:411 WALNUT ST # 20824
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3443
Mailing Address - Country:US
Mailing Address - Phone:425-381-6544
Mailing Address - Fax:425-285-7375
Practice Address - Street 1:4505 PACIFIC HWY E STE C2
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2638
Practice Address - Country:US
Practice Address - Phone:425-381-6544
Practice Address - Fax:425-285-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty