Healthcare Provider Details

I. General information

NPI: 1588536858
Provider Name (Legal Business Name): MIND GARDEN BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 E INDEPENDENCE BLVD STE D20
MATTHEWS NC
28105-5056
US

IV. Provider business mailing address

10931 E INDEPENDENCE BLVD STE D20
MATTHEWS NC
28105-5056
US

V. Phone/Fax

Practice location:
  • Phone: 704-312-0496
  • Fax: 704-519-2700
Mailing address:
  • Phone: 704-312-0496
  • Fax: 704-519-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANNON L ANES
Title or Position: MEMBER/ORGANIZER
Credential: MSN, APRN, PMHNP-BC
Phone: 704-312-0496