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General NPI Number Information
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NPI Number | 1275487936
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Entity Type | Organization
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Legal Business Name | GRACEFUL MINDS PLLC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 8154 E KAEL ST
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City | MESA
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State | AZ
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Zip | 85207-2161
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Country | US
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Telephone | 469-915-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 1666 E OLIVE WAY
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City | SEATTLE
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State | WA
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Zip | 98102-5627
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Country | US
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Telephone | 206-929-0600
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | AL BERRY
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Credential |
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Telephone | 469-915-4211
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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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