=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871407874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDSET WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1022 N 4TH ST STE 200
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-457-2909
-----------------------------------------------------
Fax | 208-450-2239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1022 N 4TH ST STE 200
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-457-2909
-----------------------------------------------------
Fax | 208-450-2239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOHN NELMAR
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 208-704-2062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------