Healthcare Provider Details

I. General information

NPI: 1609731934
Provider Name (Legal Business Name): MIND POWER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 COFFEEN AVE STE 1200
SHERIDAN WY
82801-5777
US

IV. Provider business mailing address

4435 E CHANDLER BLVD STE 200
PHOENIX AZ
85048-7651
US

V. Phone/Fax

Practice location:
  • Phone: 877-931-1598
  • Fax: 214-872-9817
Mailing address:
  • Phone: 877-931-1598
  • Fax: 214-872-9817

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: FARIDY MOMBELEUR
Title or Position: NP
Credential:
Phone: 877-931-1598