Provider Demographics
NPI:1083332910
Name:MENDING HEARTS AND MINDS THERAPY SERVICES
Entity Type:Organization
Organization Name:MENDING HEARTS AND MINDS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY-PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-872-2060
Mailing Address - Street 1:256 EAGLEVIEW BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1157
Mailing Address - Country:US
Mailing Address - Phone:484-872-2060
Mailing Address - Fax:
Practice Address - Street 1:145 LITTLE CONESTOGA RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9562
Practice Address - Country:US
Practice Address - Phone:484-872-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health