MEDICARE: ZION 360 MENTAL HEALTH AND WELLNESS L.L.C.

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	:	1639037997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZION 360 MENTAL HEALTH AND WELLNESS L.L.C.

Provider Business Mailing Address
First Line	:	5870 FULTON DR NW STE B
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-1782
Country	:	US
Telephone Number	:	330-574-4137
Fax Number	:	330-975-6044

Provider Business Practice Location Address
First Line	:	5870 FULTON DR NW STE B
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-1782
Country	:	US
Telephone Number	:	330-574-4137
Fax Number	:	330-975-6044

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BREANNA MILLSAP
Credential	:	APRN, PMHNP-BC
Telephone Number	:	330-209-6894

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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