MEDICARE: MINDOLOGY EMPOWERMENT ACADEMY INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1902748452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDOLOGY EMPOWERMENT ACADEMY INC

Provider Business Mailing Address
First Line	:	14320 VENTURA BLVD STE 179
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-2717
Country	:	US
Telephone Number	:	818-802-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 N CLARK DR APT 104
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-4703
Country	:	US
Telephone Number	:	818-802-3700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	TROY BYER
Credential	:	PSYD
Telephone Number	:	818-802-3700

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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