Healthcare Provider Details

I. General information

NPI: 1760371561
Provider Name (Legal Business Name): MINDWELL SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S SWEETZER AVE APT 303
LOS ANGELES CA
90048-6617
US

IV. Provider business mailing address

9531 SANTA MONICA BLVD # 310
BEVERLY HILLS CA
90210-4503
US

V. Phone/Fax

Practice location:
  • Phone: 424-653-3882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DUEL
Title or Position: CEO
Credential: MD
Phone: 714-742-3257