{
"Npi": {
"NPI": "1982425195",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "IMIND HEALTH LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4640 FORBES BLVD STE 375",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LANHAM",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20706-4323",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-249-0989",
"MailingAddressFaxNumber": "240-256-8887",
"FirstLinePracticeLocationAddress": "4640 FORBES BLVD STE 375",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LANHAM",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20706-4323",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-249-0989",
"PracticeLocationAddressFaxNumber": "240-256-8887",
"EnumerationDate": "10/21/2024",
"LastUpdateDate": "10/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FLYNN",
"AuthorizedOfficialFirstName": "KHANH-LINH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF OPERATING OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "703-395-2109",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}