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General NPI Number Information
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NPI Number | 1063297349
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Entity Type | Organization
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Legal Business Name | PURE MIND WORKS, PLLC
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 1608 W 17TH ST
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City | BRYAN
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State | TX
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Zip | 77803-1504
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Country | US
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Telephone | 979-739-4269
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2747
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City | BRYAN
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State | TX
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Zip | 77805-2747
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Country | US
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Telephone | 979-739-4269
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ASHLEY NELSON
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Credential | LCDC, LPC
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Telephone | 979-739-4269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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