MEDICARE: HEALING MINDS WELLNESS LLC MENTAL HEALTH CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1205603651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING MINDS WELLNESS LLC MENTAL HEALTH CLINIC

Provider Business Mailing Address
First Line	:	16616 BILTMORE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16616 BILTMORE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1442
Country	:	US
Telephone Number	:	216-798-7433
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	LISA SULLIVAN
Credential	:
Telephone Number	:	440-453-0754

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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