MEDICARE: MINDQUESTPT, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1831052018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDQUESTPT, LLC.

Provider Business Mailing Address
First Line	:	3812 CARMONA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1013
Country	:	US
Telephone Number	:	310-773-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3812 CARMONA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1013
Country	:	US
Telephone Number	:	310-773-2313
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. JEROM PATRICK HENRY JR.
Credential	:
Telephone Number	:	310-773-2313

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “MINDQUESTPT, LLC. ” Practice Location

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