Healthcare Provider Details

I. General information

NPI: 1871407874
Provider Name (Legal Business Name): MINDSET WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 N 4TH ST STE 200
COEUR D ALENE ID
83814-3100
US

IV. Provider business mailing address

1022 N 4TH ST STE 200
COEUR D ALENE ID
83814-3100
US

V. Phone/Fax

Practice location:
  • Phone: 208-457-2909
  • Fax: 208-450-2239
Mailing address:
  • Phone: 208-457-2909
  • Fax: 208-450-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN NELMAR
Title or Position: OWNER
Credential: LCPC
Phone: 208-704-2062