=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801765581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSCEND MIND-BODY WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2025
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 SW 4TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97204-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-464-2201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 WASHINGTON ST
-----------------------------------------------------
City | CEDAR FALLS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50613-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-464-2201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | BRADY JOHN HULS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-269-1505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------