Healthcare Provider Details

I. General information

NPI: 1003769993
Provider Name (Legal Business Name): ELITE MINDS PEAK PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 01/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 THE EXCHANGE SE STE 220
ATLANTA GA
30339-2171
US

IV. Provider business mailing address

1870 THE EXCHANGE SE STE 220
ATLANTA GA
30339-2171
US

V. Phone/Fax

Practice location:
  • Phone: 269-352-3753
  • Fax: 269-352-3753
Mailing address:
  • Phone: 269-352-3753
  • Fax: 269-352-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MILENA MASK
Title or Position: CEO/OWNER
Credential: NP
Phone: 269-352-3753