Provider Demographics
NPI:1417686973
Name:THE HEALED MIND LLC
Entity Type:Organization
Organization Name:THE HEALED MIND LLC
Other - Org Name:THE HEALED MIND PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDUBUISI
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:ODEGAI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:972-483-5380
Mailing Address - Street 1:703 S HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5534
Mailing Address - Country:US
Mailing Address - Phone:972-483-5380
Mailing Address - Fax:972-217-4773
Practice Address - Street 1:703 S HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-5534
Practice Address - Country:US
Practice Address - Phone:972-483-5380
Practice Address - Fax:972-217-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty