Provider Demographics
NPI:1083221543
Name:NU MINDSET PLLC
Entity Type:Organization
Organization Name:NU MINDSET PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATARELLI-MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-522-7419
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-0924
Mailing Address - Country:US
Mailing Address - Phone:810-522-7419
Mailing Address - Fax:
Practice Address - Street 1:2311 SHELBY AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3849
Practice Address - Country:US
Practice Address - Phone:810-522-7419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty