MEDICARE: HEALTHY MIND WELLNESS AND 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1760050595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MIND WELLNESS AND PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	230 NORTHLAND BLVD STE 127
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-0015
Country	:	US
Telephone Number	:	513-507-7125
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 NORTHLAND BLVD STE 127
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-0015
Country	:	US
Telephone Number	:	513-507-7125
Fax Number	:

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	MS. TONI DENIESE MASON
Credential	:	CNP
Telephone Number	:	513-507-7125

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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