Healthcare Provider Details

I. General information

NPI: 1538875125
Provider Name (Legal Business Name): MIND 247 PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S HIGLEY RD STE 201
MESA AZ
85206-4002
US

IV. Provider business mailing address

PO BOX 459
HIGLEY AZ
85236-0459
US

V. Phone/Fax

Practice location:
  • Phone: 844-646-3247
  • Fax: 480-546-4048
Mailing address:
  • Phone: 844-646-3247
  • Fax: 480-805-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRICK D BRAATZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 844-646-3247