Healthcare Provider Details

I. General information

NPI: 1053170886
Provider Name (Legal Business Name): MINDS-N-MOTION WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10927 MAHONING AVE
NORTH JACKSON OH
44451-8705
US

IV. Provider business mailing address

507 WILCOX RD APT A
YOUNGSTOWN OH
44515-6229
US

V. Phone/Fax

Practice location:
  • Phone: 844-408-3998
  • Fax: 330-953-2300
Mailing address:
  • Phone: 740-317-3237
  • Fax: 330-953-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA NOVITS
Title or Position: NURSE PRACTITIONER
Credential: APRN, FNP-C,PMHNP-C
Phone: 844-408-3998