Provider Demographics
NPI:1154160604
Name:STATE OF MIND
Entity type:Organization
Organization Name:STATE OF MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:EAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ARNP, PMHNP-BC
Authorized Official - Phone:509-969-3908
Mailing Address - Street 1:11202 COTTONWOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9372
Mailing Address - Country:US
Mailing Address - Phone:509-969-3908
Mailing Address - Fax:509-873-7188
Practice Address - Street 1:411 S 12TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3109
Practice Address - Country:US
Practice Address - Phone:509-969-3908
Practice Address - Fax:509-873-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty