Healthcare Provider Details

I. General information

NPI: 1124707765
Provider Name (Legal Business Name): MIND CHANGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 CANAL BANK DR
SLIDELL LA
70461-6644
US

IV. Provider business mailing address

PO BOX 85
KAPLAN LA
70548-0085
US

V. Phone/Fax

Practice location:
  • Phone: 504-875-9443
  • Fax: 337-643-8407
Mailing address:
  • Phone: 337-643-8424
  • Fax: 337-643-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VANESSA DOMINGUE
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-643-8424