Provider Demographics
NPI:1003495896
Name:MINDHEALTHY PC
Entity Type:Organization
Organization Name:MINDHEALTHY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-411-1520
Mailing Address - Street 1:909 AVIATION PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6603
Mailing Address - Country:US
Mailing Address - Phone:888-510-1352
Mailing Address - Fax:
Practice Address - Street 1:909 AVIATION PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6603
Practice Address - Country:US
Practice Address - Phone:888-510-1352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder