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General NPI Number Information
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NPI Number | 1407564974
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Entity Type | Organization
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Legal Business Name | MINDSET BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 445 MARSHALL ST STE 149
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2695
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Country | US
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Telephone | 732-648-4282
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Fax |
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Provider Business Mailing Address
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Address Line | 445 MARSHALL ST STE 149
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2695
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Country | US
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Telephone | 732-648-4282
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MR. SAMUEL AMPONASH
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Credential | NURSE PRACTIONER
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Telephone | 732-648-4282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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