MEDICARE: BEAUTIFUL MINDS LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1326657909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL MINDS LLC

Provider Business Mailing Address
First Line	:	3501 ASHMERE LOOP
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-1013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 S MAYS ST STE 112
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6700
Country	:	US
Telephone Number	:	512-537-7504
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	JENNIFER BEATTY
Credential	:
Telephone Number	:	512-573-7504

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

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Directions to “BEAUTIFUL MINDS LLC ” Practice Location

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