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Organization
WHOLESOME COMMUNITY MEMBERS CLUB INC
Active
Organization
WHOLESOME COMMUNITY MEMBERS CLUB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVIN DOUGLAS MITCHELL PMHNP-BC (NURSE PRACTITIONER)
(818) 239-9586
Entity
Organization
Contact information
Practice address
6309 VAN NUYS BLVD STE 102, VAN NUYS, CA 91401-6629
(818) 239-9586
Mailing address
PO BOX 1763, SUN VALLEY, CA 91353-1763
(818) 239-9586
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
251V00000X
Voluntary or Charitable Agency
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/05/2018
Last updated
04/10/2019
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