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1497625552 NPI number — COLLABORATING MINDS MENTAL HEALTH & WELLNESS LLC

NPI Number: 1497625552
Health Care Provider/Practitioner: COLLABORATING MINDS MENTAL HEALTH & WELLNESS LLC

Information about “1497625552” NPI (COLLABORATING MINDS MENTAL HEALTH & WELLNESS LLC) exists in 1497625552 in HTML format HTML  |  1497625552 in plain Text format TXT  |  1497625552 in PDF (Portable Document Format) PDF  |  1497625552 in an XML format XML  formats.

NPI Number : 1497625552 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497625552",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COLLABORATING MINDS MENTAL HEALTH & WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "485 S PERRY ST STE A9",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAWRENCEVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30046-4923",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-226-1475",
    "MailingAddressFaxNumber": "678-404-8099",
    "FirstLinePracticeLocationAddress": "485 S PERRY ST STE A9-10",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAWRENCEVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30046-4923",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-668-9794",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/05/2025",
    "LastUpdateDate": "12/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CARSWELL",
    "AuthorizedOfficialFirstName": "CHASITY",
    "AuthorizedOfficialMiddleName": "J",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP, FNP-C, PMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "770-315-8634",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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