IMANI MENTAL HEALTH AND WELLNESS LLC (NPI# 1104415405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104415405 |
| Entity Type | Organization |
| Organization Name | IMANI MENTAL HEALTH AND WELLNESS LLC |
| Practice Address | 3939 Ne Hancock St # 202 Portland OR 97212-5321 |
| Practice Telephone | 2144581713 |
| Mailing Address | 12063 Sw Taylor Ct Portland OR 97225-5845 |
| Mailing Telephone | 2144581713 |
| Certification Date | 2021-01-25 |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-25 |
| Authorized Official Telephone | 2144581713 |
| Authorized Official Credential | PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | Taxonomy Group | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|---|
| Y | 363LP0808X | Nurse Practitioner Specialization: Psychiatric/Mental Health | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers |
| Endpoint Type | Endpoint | Affiliation | Affiliation Address | Use | Content |
|---|---|---|---|---|---|
| CONNECT URL | imanimentalhealthwellness@gmail.com (business email address) | 3939 Ne Hancock St # 202, Portland, OR 972125321 | Health Information Exchange (HIE) | Other email |
| Street Address | 3939 NE HANCOCK ST # 202 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97212-5321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003380478 | Emily R Hinman | Counselor · Professional | 3939 Ne Hancock St Ste 209, Portland, OR 97212-5321 | 2019-01-17 |
| 1326548892 | Forest Mountain Corporation | Acupuncturist | 3939 Ne Hancock St Ste 217, Portland, OR 97212-5321 | 2018-02-20 |
| 1932503539 | Susan Mbugua | Nurse Practitioner · Psychiatric/Mental Health | 3939 Ne Hancock St Ste 202, Portland, OR 97212-5321 | 2014-10-10 |
| 1396056727 | Nathan M Smith | Nurse Practitioner · Psychiatric/Mental Health | 3939 Ne Hancock St Ste Sf1, Portland, OR 97212-5321 | 2010-06-30 |
| 1205167160 | Rebecca M Dodge | Psychologist · Clinical | 3939 Ne Hancock St # 316, Portland, OR 97212-5321 | 2010-01-15 |
| 1033353362 | Peggy S. Nydahl | Counselor · Professional | 3939 Ne Hancock St Ste 117, Portland, OR 97212-5321 | 2009-04-30 |
| 1609014661 | Tracie Jill Mccall | Specialist | 3939 Ne Hancock St Ste 307, Portland, OR 97212-5321 | 2009-01-29 |
| 1790815900 | Mary Louise Miyakawa | Social Worker · Clinical | 3939 Ne Hancock St Ste 210, Portland, OR 97212-5321 | 2007-03-06 |
| 1538226386 | Stephen R. Beck | Social Worker | 3939 Ne Hancock St # 302, Portland, OR 97212-5321 | 2007-01-02 |
| 1588765671 | Catherine M Melo | Social Worker · Clinical | 3939 Ne Hancock St Ste 208, Portland, OR 97212-5321 | 2006-09-25 |
| Find all providers in zip 97212-5321 | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205423704 | Oregon Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1821 Ne 33rd Avenue, Portland, OR 97212 | 2020-12-30 |
| 1497223051 | Shira Dennis | Behavior Analyst | 3424 Ne Tillamook St., Portland, OR 97212 | 2018-11-12 |
| 1659890317 | Cidnee Potter | Doula | 2915 Ne Mlk Jr Blvd, Portland, OR 97212 | 2017-09-14 |
| 1588194187 | Ann M Staple | Counselor · Mental Health | 2905 Ne Tillamook St, Portland, OR 97212 | 2017-06-15 |
| 1780129502 | Noelle Denise King | Naturopath | 2540 Ne Martin Luther King Jr Blvd Femelle Integrative, Suite A, Portland, OR 97212 | 2017-01-03 |
| 1285085100 | Jessica Battin | Massage Therapist | 2310 Ne 8th Ave #2, Portland, OR 97212 | 2016-06-22 |
| 1316311830 | Dr Elise Schroeder | Clinic/Center | 3531 Ne 15th Ave Suite A, Portland, OR 97212 | 2015-11-20 |
| 1467820738 | Ayanna Askari | Counselor · Addiction (Substance Use Disorder) | 3655 N E Grand Ave, Portland, OR 97212 | 2015-09-03 |
| 1053797167 | Iliana Henriquez | Social Worker · School | 3500 Ne Martin Luther King Blvd Suite 200, Portland, OR 97212 | 2015-07-31 |
| 1417346834 | Emily Mcdonough Comerford | Case Manager/Care Coordinator | 1823 Ne 8th Avenue, Kinship House, Portland, OR 97212 | 2015-01-22 |
| Find all providers in zip 97212 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psychiatric/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154920148 | Hardcore Happy LLC | 740 Ne 116th Ct, Portland, OR 97220-2223 | 2020-10-20 | |
| 1457967325 | Megan L Langworthy | 1914 Se 46th Ave, Portland, OR 97215-3148 | 2020-09-16 | |
| 1104446681 | Skycloud Psychiatry LLC | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 | |
| 1730712290 | Lucy Anne Bloedon | 4020 Sw Iowa St, Portland, OR 97221-3423 | 2020-02-12 | |
| 1346802733 | Compass Psychiatric Wellness LLC | 4300 Ne Fremont St Ste 260, Portland, OR 97213-1100 | 2019-07-05 | |
| 1548721871 | Cooke Therapy Pllc | 1125 Se Madison St Ste 102, Portland, OR 97214-3600 | 2019-03-28 | |
| 1245719541 | Scott J Whited | 216 Vaughan St., Mcgeachy Hall, Portland, ME 04101 | 2018-08-08 | |
| 1467969220 | Nw Mind-Body Wellness, LLC | 16986 Nw Lynch Ln, Portland, OR 97229-1221 | 2018-01-02 | |
| 1811441348 | Anthony Hoy | 5562 Se Pine St, Portland, OR 97215-1276 | 2016-08-12 | |
| 1700241254 | Jacqueline J Cole · Jacqueline J Rhatican | 5228 Ne Hoyt St Ste 300, Portland, OR 97213-3055 | 2015-12-29 | |
| Find all providers in PORTLAND | ||||
| City | PORTLAND |
| Zip Code | 97212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366991697 | M Mental Health and Wellness Plus · M Mental Health and Wellness Plus | Community/Behavioral Health | 46000 Powder Mill Road, Suite 450-I, Beltsville, MD 20705-1383 | 2016-09-28 |
| 1902454325 | Coh Mental Health Wellness LLC · Coh Mental Health Wellness | Community/Behavioral Health | 500 Main St, Moosic, PA 18507-1089 | 2019-08-28 |
| 1639703879 | Imani Mental Health Services LLC | Nurse Practitioner · Psychiatric/Mental Health | 18672 E Old Beau Trl, Queen Creek, AZ 85142-3521 | 2020-02-26 |
| 1568077709 | Shalom Mental Health and Wellness Inc · Shalom Mental Health and Wellness | Registered Nurse · Psychiatric/Mental Health | 3157 N University Dr, Hollywood, FL 33024-2258 | 2020-09-14 |
| 1881816643 | Services for The Underserved - Mental Health Programs Inc · Sus Wellness Works Mental Health Clinic | Social Worker · Clinical | 305 7th Ave, New York, NY 10001-6008 | 2007-05-02 |
| 1053696195 | Sus Mental Health Programs, Inc. · Sus Wellness Works Mental Health Clinic | Social Worker · Clinical | 1125 Fulton St, Brooklyn, NY 11238-2669 | 2011-10-20 |
| 1568011880 | Advanced Action Mental Health Np, A Professional Nursing Corporation · Aa Mental Health and Wellness Group | Nurse Practitioner · Psychiatric/Mental Health | 5182 Katella Ave Ste 205, Los Alamitos, CA 90720-2857 | 2019-09-09 |
| 1114588241 | Mosaic Mental Wellness · Mosaic Mental Wellness and Health | Counselor · Mental Health | 3005 Peters Creek Rd Nw, Roanoke, VA 24019-2738 | 2019-06-28 |
| 1992227425 | Anchor Mental Health and Wellness, Pllc · Anchor Mental Health and Wellness, Pllc | Nurse Practitioner · Psychiatric/Mental Health | 4250 5th Ave, Lake Charles, LA 70607-3900 | 2017-07-17 |
| 1598876971 | The Imani Group · Imani Health Associates | Clinic/Center · Physical Therapy | 6917 Cullen Blvd, Houston, TX 77021-5009 | 2006-08-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.