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General NPI Number Information
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NPI Number | 1972284727
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Entity Type | Organization
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Legal Business Name | HEALTHY MINDS WELLNESS CENTER CORP
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 2942 N 24TH ST STE 24
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City | PHOENIX
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State | AZ
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Zip | 85016-7844
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Country | US
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Telephone | 702-790-4932
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 N 24TH ST STE 24
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City | PHOENIX
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State | AZ
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Zip | 85016-7844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEPHEN YOUNG
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Credential |
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Telephone | 702-790-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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