Healthcare Provider Details

I. General information

NPI: 1952245482
Provider Name (Legal Business Name): UNPLUGGED MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CEDAR AVE
CRESTVIEW FL
32536-2734
US

IV. Provider business mailing address

114 CEDAR AVE
CRESTVIEW FL
32536-2734
US

V. Phone/Fax

Practice location:
  • Phone: 850-533-0778
  • Fax:
Mailing address:
  • Phone: 850-533-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. AUDRA ELIZABETH NESSETH
Title or Position: OWNER
Credential:
Phone: 850-974-5372