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General NPI Number Information
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NPI Number | 1689299836
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Entity Type | Organization
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Legal Business Name | MINDWEAL HEALTH, PLLC
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Dates
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Enumeration Date | 06/13/2020
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 24B PROFESSIONAL PARK DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5856
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Country | US
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Telephone | 618-310-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 24B PROFESSIONAL PARK DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5856
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Country | US
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Telephone | 618-310-0085
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Fax |
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Authorized Official
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Title or Position | CEO & MEDICAL DIRECTOR
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Name | DR. RAHUL BANSAL
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Credential | MD
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Telephone | 618-310-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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