Healthcare Provider Details

I. General information

NPI: 1073879813
Provider Name (Legal Business Name): HEART MIND CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WINDMILL RD
EDGEWOOD NM
87015-6918
US

IV. Provider business mailing address

28 WINDMILL RD
EDGEWOOD NM
87015-6918
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-7025
  • Fax:
Mailing address:
  • Phone: 505-288-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA A WOLF
Title or Position: CLINICAL COUNSELOR
Credential: LPCC
Phone: 150-288-7025