=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568228229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEFUL MINDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2024
-----------------------------------------------------
Last Update Date | 02/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5742 ADAMS AVE PKWY STE C
-----------------------------------------------------
City | WASHINGTON TERRACE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84405-7158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-974-2470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13889 S CORA B LN
-----------------------------------------------------
City | HERRIMAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84096-6940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-974-2470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP-C, PMHNP-BC
-----------------------------------------------------
Name | NANCY RAYMOND
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 301-974-2470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------