Provider Demographics
NPI:1841928355
Name:HOPE MENTAL WELLNESS SERVICES PLLC
Entity type:Organization
Organization Name:HOPE MENTAL WELLNESS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH MENTAL HEALTH NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIPPY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:419-234-1476
Mailing Address - Street 1:4959 SIDNEY RD SW APT 206
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6015
Mailing Address - Country:US
Mailing Address - Phone:419-234-1476
Mailing Address - Fax:
Practice Address - Street 1:4959 SIDNEY RD SW APT 206
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6015
Practice Address - Country:US
Practice Address - Phone:419-234-1476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service