Healthcare Provider Details

I. General information

NPI: 1659097848
Provider Name (Legal Business Name): MENDING MIND THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 E FIDDLERS CANYON RD
CEDAR CITY UT
84721-9495
US

IV. Provider business mailing address

PO BOX 1842
CEDAR CITY UT
84721-1842
US

V. Phone/Fax

Practice location:
  • Phone: 435-559-3620
  • Fax:
Mailing address:
  • Phone: 435-559-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KENDRA JONES
Title or Position: COUNSELOR
Credential: CMHC
Phone: 435-559-3620