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General NPI Number Information
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NPI Number | 1316674435
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Entity Type | Organization
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Legal Business Name | MENDING MINDS MENTAL HEALTH LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 305 N ELLEN ST
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City | CEDAR FALLS
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State | IA
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Zip | 50613-2129
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Country | US
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Telephone | 319-230-4069
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N ELLEN ST
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City | CEDAR FALLS
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State | IA
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Zip | 50613-2129
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Country | US
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Telephone | 319-230-4069
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MAGGIE MAE AUSTIN
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Credential | PMHNP
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Telephone | 319-230-4069
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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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