Healthcare Provider Details

I. General information

NPI: 1750296976
Provider Name (Legal Business Name): BEAUTIFUL MINDS BEHAVIORAL CONSULTATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SOUTHGATE RD APT 38
MIDDLETOWN NY
10940-2065
US

IV. Provider business mailing address

2 SOUTHGATE RD APT 38
MIDDLETOWN NY
10940-2065
US

V. Phone/Fax

Practice location:
  • Phone: 917-569-9407
  • Fax:
Mailing address:
  • Phone: 917-569-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADRIENNE WILLIS-CONNPRS
Title or Position: OWNER
Credential: MS, CSP
Phone: 917-569-9407