Healthcare Provider Details

I. General information

NPI: 1346931169
Provider Name (Legal Business Name): MINDSET BEHAVIORAL HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1843 BRIGHTSEAT RD
HYATTSVILLE MD
20785
US

IV. Provider business mailing address

1843 BRIGHTSEAT RD
HYATTSVILLE MD
20785
US

V. Phone/Fax

Practice location:
  • Phone: 240-825-3173
  • Fax: 240-691-0279
Mailing address:
  • Phone: 240-825-3173
  • Fax: 240-691-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLUFUNMILAYO ONUOHA
Title or Position: OWNER
Credential: CRNP
Phone: 240-825-3173