Provider Demographics
NPI:1215541669
Name:MYNDSPACE MENTAL HEALTH EDUCATION & CONSULTING, LLC
Entity Type:Organization
Organization Name:MYNDSPACE MENTAL HEALTH EDUCATION & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CERRISSA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HUGIE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:803-351-8252
Mailing Address - Street 1:111 BANTRY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8089
Mailing Address - Country:US
Mailing Address - Phone:803-351-8252
Mailing Address - Fax:
Practice Address - Street 1:111 BANTRY CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-8089
Practice Address - Country:US
Practice Address - Phone:803-351-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty