MEDICARE: BEAUTIFUL MINDS GROUP 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	103TM1800X	Intellectual & Developmental Disabilities Psychologist
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1982576641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL MINDS GROUP LLC

Provider Business Mailing Address
First Line	:	1225 N MAIN ST
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44720-1959
Country	:	US
Telephone Number	:	330-618-5246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 N MAIN ST
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44720-1959
Country	:	US
Telephone Number	:	330-618-5246
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JIBREEL N HAZLY
Credential	:
Telephone Number	:	330-618-5246

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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