Healthcare Provider Details

I. General information

NPI: 1003534165
Provider Name (Legal Business Name): MINDFLOW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 VIRGINIA WAY
BRENTWOOD TN
37027-7531
US

IV. Provider business mailing address

5341 VIRGINIA WAY
BRENTWOOD TN
37027-7531
US

V. Phone/Fax

Practice location:
  • Phone: 205-903-2483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GERALD ANTHONY FARAINO JR.
Title or Position: CEO
Credential:
Phone: 205-903-2483