Healthcare Provider Details

I. General information

NPI: 1598620585
Provider Name (Legal Business Name): MENDING MINDS THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 DENVER YORK LN
TIGER GA
30576-1995
US

IV. Provider business mailing address

126 DENVER YORK LN
TIGER GA
30576-1995
US

V. Phone/Fax

Practice location:
  • Phone: 706-490-3932
  • Fax:
Mailing address:
  • Phone: 706-490-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GEORGIA O'NEIL YOUNG
Title or Position: LPC/OWNER
Credential: LPC
Phone: 706-490-3932