=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841983640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDTUNES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2023
-----------------------------------------------------
Last Update Date | 05/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 S 56TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19143-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-989-9811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 391 WILMINGTON PIKE STE 3112
-----------------------------------------------------
City | GLEN MILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19342-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-989-9811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REMBURSEMENT DIRECTOR
-----------------------------------------------------
Name | MS. JAMILAH NOLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-466-1408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------