Provider Demographics
NPI:1386404077
Name:COUPE DE MAITRE WELLBEING LLC
Entity type:Organization
Organization Name:COUPE DE MAITRE WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:478-454-7343
Mailing Address - Street 1:370 SOUTHERN WALK DR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7785
Mailing Address - Country:US
Mailing Address - Phone:478-454-7343
Mailing Address - Fax:
Practice Address - Street 1:370 SOUTHERN WALK DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7785
Practice Address - Country:US
Practice Address - Phone:478-454-7343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty