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General NPI Number Information
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NPI Number | 1114883865
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Entity Type | Organization
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Legal Business Name | MIND SPA, LLC
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Dates
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Enumeration Date | 12/26/2025
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 15900 W 10 MILE RD STE 211
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2079
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Country | US
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Telephone | 888-908-6887
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Fax | 248-800-7266
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Provider Business Mailing Address
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Address Line | 15900 W 10 MILE RD STE 211
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2079
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Country | US
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Telephone | 888-908-6887
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Fax | 248-800-7266
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Authorized Official
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Title or Position | PMHNP-BC
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Name | BRANDI DENISE SYKES
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Credential | MSN, APRN
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Telephone | 248-766-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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