Healthcare Provider Details

I. General information

NPI: 1033875190
Provider Name (Legal Business Name): WHOLE MIND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 E END RD STE 3
HOMER AK
99603-7250
US

IV. Provider business mailing address

PO BOX 401
HOMER AK
99603-0401
US

V. Phone/Fax

Practice location:
  • Phone: 907-299-6410
  • Fax:
Mailing address:
  • Phone: 907-299-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDY ZOLLARS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 267-733-2695