Provider Demographics
NPI:1083330682
Name:MIND 247 PRACTICE LLC
Entity Type:Organization
Organization Name:MIND 247 PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-646-3247
Mailing Address - Street 1:1465 N SCOTTSDALE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3634
Mailing Address - Country:US
Mailing Address - Phone:844-084-7992
Mailing Address - Fax:
Practice Address - Street 1:2728 N 24TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1051
Practice Address - Country:US
Practice Address - Phone:844-646-3247
Practice Address - Fax:480-546-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health