Healthcare Provider Details

I. General information

NPI: 1043114648
Provider Name (Legal Business Name): QUIET MIND PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FOLEY ST
SANTA ROSA CA
95401-4209
US

IV. Provider business mailing address

PO BOX 19231
SACRAMENTO CA
95819-0231
US

V. Phone/Fax

Practice location:
  • Phone: 916-234-3301
  • Fax:
Mailing address:
  • Phone: 916-234-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN COURDY
Title or Position: CEO
Credential: MD
Phone: 916-234-3301