Healthcare Provider Details

I. General information

NPI: 1902545981
Provider Name (Legal Business Name): MINDSET FOR PROSPERITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 10TH ST NE
ROME GA
30165-2640
US

IV. Provider business mailing address

409 W 10TH ST NE
ROME GA
30165-2640
US

V. Phone/Fax

Practice location:
  • Phone: 706-406-5093
  • Fax:
Mailing address:
  • Phone: 706-406-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORI LEONARD
Title or Position: OWNER
Credential: APRN, PMHNP
Phone: 706-406-5093