Healthcare Provider Details

I. General information

NPI: 1225852908
Provider Name (Legal Business Name): INTEGRATED MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SAINT PAUL DR
FREMONT OH
43420-9045
US

IV. Provider business mailing address

140 SAINT PAUL DR
FREMONT OH
43420-9045
US

V. Phone/Fax

Practice location:
  • Phone: 419-680-5152
  • Fax:
Mailing address:
  • Phone: 419-680-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. THERESA MARIE MILLS
Title or Position: OWNER
Credential: MSN, APRN, PMHNP-BC
Phone: 419-680-5152