Healthcare Provider Details

I. General information

NPI: 1356177612
Provider Name (Legal Business Name): MERRY MIND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 11/28/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 DARBY RD STE Z
PAOLI PA
19301-1472
US

IV. Provider business mailing address

53 DARBY RD STE Z
PAOLI PA
19301-1472
US

V. Phone/Fax

Practice location:
  • Phone: 201-657-0127
  • Fax:
Mailing address:
  • Phone: 610-500-6355
  • Fax: 252-300-3738

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: MS. MEREDITH LEIGH MCPHERSON
Title or Position: OWNER
Credential: CRNP, PMHNP-BC
Phone: 610-500-6355