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General NPI Number Information
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NPI Number | 1316834724
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Entity Type | Organization
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Legal Business Name | MINDSPIRE MENTAL HEALTH & WELLNESS NURSING CORPORATION
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 1775 E PALM CANYON DRIVE 110-5020
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City | PALM SPRINGS
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State | CA
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Zip | 92264-1613
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Country | US
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Telephone | 424-888-0608
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 E PALM CANYON DR STE 110-50
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City | PALM SPRINGS
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State | CA
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Zip | 92264-1613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NP
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Name | JOSE BANUELOS
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Credential | PMHNP-BC
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Telephone | 424-888-0608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/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 | 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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