MEDICARE: MIND BY DESIGN WELLNESS CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1669176566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND BY DESIGN WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	78000 FRED WARING DR STE 102
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-9266
Country	:	US
Telephone Number	:	760-308-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	78000 FRED WARING DR STE 102
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-9266
Country	:	US
Telephone Number	:	760-308-2600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DARCY AVILES
Credential	:	LPCC
Telephone Number	:	760-308-2600

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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