Healthcare Provider Details

I. General information

NPI: 1952262008
Provider Name (Legal Business Name): NOUVEAU MIND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 WOODMAN DR STE 380
KETTERING OH
45420-1159
US

IV. Provider business mailing address

3085 WOODMAN DR STE 380
KETTERING OH
45420-1159
US

V. Phone/Fax

Practice location:
  • Phone: 513-560-9586
  • Fax:
Mailing address:
  • Phone: 513-560-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HAOUA CONGO
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential:
Phone: 513-560-9586