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General NPI Number Information
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NPI Number | 1447105903
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Entity Type | Organization
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Legal Business Name | FULLMYND INTEGRATIVE PSYCHIATRY & WELLNESS, A NURSING PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 43700 17TH ST W STE 201
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City | LANCASTER
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State | CA
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Zip | 93534-4661
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Country | US
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Telephone | 805-424-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST # 6199
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 805-424-2674
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DESIREE OLAN
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Credential | DNP, PMHNP-BC
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Telephone | 805-424-2674
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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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