Provider Demographics
NPI:1497438204
Name:MIND WELLNESS, LLC
Entity Type:Organization
Organization Name:MIND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCQUARTERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-574-5124
Mailing Address - Street 1:1840 SOUTH LIONS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-574-5124
Mailing Address - Fax:
Practice Address - Street 1:600 17TH STREET
Practice Address - Street 2:SUITE 2800-SOUTH
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202
Practice Address - Country:US
Practice Address - Phone:918-574-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health