Healthcare Provider Details

I. General information

NPI: 1336809847
Provider Name (Legal Business Name): BEAUTIFUL MINDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 CHARNELTON ST
EUGENE OR
97401-3431
US

IV. Provider business mailing address

1178 CHARNELTON ST
EUGENE OR
97401-3431
US

V. Phone/Fax

Practice location:
  • Phone: 541-777-8805
  • Fax: 541-314-9597
Mailing address:
  • Phone: 541-777-8805
  • Fax: 541-314-9597

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: BECCA D HENRY
Title or Position: BUSINESS OWNER
Credential: PMHNP
Phone: 410-382-2509