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General NPI Number Information
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NPI Number | 1275497224
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Entity Type | Organization
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Legal Business Name | MINDWELL COLLECTIVE
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 12625 HIGH BLUFF DR STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92130-2053
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Country | US
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Telephone | 858-877-1860
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Fax | 855-554-1110
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Provider Business Mailing Address
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Address Line | 12625 HIGH BLUFF DR STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92130-2053
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Country | US
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Telephone | 858-877-1860
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Fax | 855-554-1110
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AMIN GHOLAMI
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Credential |
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Telephone | 858-877-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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