=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417824236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLADMIND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9894 BISSONNET ST STE 100U
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-667-4998
-----------------------------------------------------
Fax | 281-971-0056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9894 BISSONNET ST STE 100U
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-667-4998
-----------------------------------------------------
Fax | 281-971-0056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | GLADYS CHIDIEBERE EZEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-762-7348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------