Healthcare Provider Details

I. General information

NPI: 1972284727
Provider Name (Legal Business Name): HEALTHY MINDS WELLNESS CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 N 24TH ST STE 24
PHOENIX AZ
85016-7844
US

IV. Provider business mailing address

2942 N 24TH ST STE 24
PHOENIX AZ
85016-7844
US

V. Phone/Fax

Practice location:
  • Phone: 702-790-4932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN YOUNG
Title or Position: DIRECTOR
Credential:
Phone: 702-790-4932