Provider Demographics
NPI:1346073814
Name:PROSPERA MHW INC.
Entity type:Organization
Organization Name:PROSPERA MHW INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-407-0988
Mailing Address - Street 1:2120 CONTRA COSTA BLVD # 1155
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3742
Mailing Address - Country:US
Mailing Address - Phone:415-407-0988
Mailing Address - Fax:
Practice Address - Street 1:3249 MARLENE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4723
Practice Address - Country:US
Practice Address - Phone:415-407-0988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty