Provider Demographics
NPI:1164129292
Name:BEAUTIFUL MINDS WELLNESS
Entity Type:Organization
Organization Name:BEAUTIFUL MINDS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-217-3870
Mailing Address - Street 1:13300 NEW AIRPORT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-7407
Mailing Address - Country:US
Mailing Address - Phone:530-217-3870
Mailing Address - Fax:
Practice Address - Street 1:13300 NEW AIRPORT RD STE 102
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-7407
Practice Address - Country:US
Practice Address - Phone:530-217-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty