MEDICARE: GLADMIND WELLNESS PLLC

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1417824236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADMIND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	9894 BISSONNET ST STE 100U
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8229
Country	:	US
Telephone Number	:	281-667-4998
Fax Number	:	281-971-0056

Provider Business Practice Location Address
First Line	:	9894 BISSONNET ST STE 100U
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8229
Country	:	US
Telephone Number	:	281-667-4998
Fax Number	:	281-971-0056

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GLADYS CHIDIEBERE EZEM
Credential	:
Telephone Number	:	832-762-7348

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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