Healthcare Provider Details

I. General information

NPI: 1003495896
Provider Name (Legal Business Name): MINDHEALTHY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVIATION PKWY STE 400
MORRISVILLE NC
27560-6603
US

IV. Provider business mailing address

909 AVIATION PKWY STE 400
MORRISVILLE NC
27560-6603
US

V. Phone/Fax

Practice location:
  • Phone: 888-510-1352
  • Fax:
Mailing address:
  • Phone: 888-510-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE GANS
Title or Position: CEO
Credential:
Phone: 888-411-1520