MEDICARE: MIND EASE PSYCHOTHERAPY, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1528856655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND EASE PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	24285 KATY FWY STE 300
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-1128
Country	:	US
Telephone Number	:	646-991-0569
Fax Number	:

Provider Business Practice Location Address
First Line	:	3819 HORDLEY TERRACE TRL
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2514
Country	:	US
Telephone Number	:	346-818-4903
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	CHARITY OMOREGIE
Credential	:	LCSW
Telephone Number	:	346-818-4903

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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