MEDICARE: FLEXMIND WELLNESS CENTER, 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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740037860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLEXMIND WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	3870 BROOKGREEN PT
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-5631
Country	:	US
Telephone Number	:	509-294-3154
Fax Number	:

Provider Business Practice Location Address
First Line	:	3870 BROOKGREEN PT
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-5631
Country	:	US
Telephone Number	:	509-294-3154
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. NICHOLAS CLAYMORE
Credential	:	BCBA
Telephone Number	:	509-294-3154

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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