Healthcare Provider Details

I. General information

NPI: 1366133902
Provider Name (Legal Business Name): HEALTHY MINDS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE STE 2020
MESA AZ
85206-6213
US

IV. Provider business mailing address

3745 E DEWBERRY AVE
MESA AZ
85206-1806
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-0829
  • Fax:
Mailing address:
  • Phone: 480-694-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA CLOYD
Title or Position: LICENSED PROFESSIONAL COUNSELOR/OWN
Credential: LPC
Phone: 480-694-7955