Healthcare Provider Details

I. General information

NPI: 1912844192
Provider Name (Legal Business Name): MENTAL PHYSIQUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E TURKEYFOOT LAKE RD
GREEN OH
44312-5365
US

IV. Provider business mailing address

5124 WILLOW CREST AVE
AUSTINTOWN OH
44515-3954
US

V. Phone/Fax

Practice location:
  • Phone: 330-442-5663
  • Fax:
Mailing address:
  • Phone: 330-442-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEDY ZENDER
Title or Position: OWNER
Credential: DNP
Phone: 330-442-5663