MEDICARE: MINDSPIRE MENTAL HEALTH & WELLNESS NURSING CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1316834724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDSPIRE MENTAL HEALTH & WELLNESS NURSING CORPORATION

Provider Business Mailing Address
First Line	:	1775 E PALM CANYON DR STE 110-50
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 E PALM CANYON DRIVE
Second Line	:	110-5020
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1613
Country	:	US
Telephone Number	:	424-888-0608
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	JOSE BANUELOS
Credential	:	PMHNP-BC
Telephone Number	:	424-888-0608

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	02/05/2026

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