Provider Demographics
NPI:1497472732
Name:MENDING MINDS PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:MENDING MINDS PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:410-474-1765
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:TAYLORS ISLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21669-0184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4407 PINE TOP ROAD
Practice Address - Street 2:
Practice Address - City:TAYLORS ISLAND
Practice Address - State:MD
Practice Address - Zip Code:21669
Practice Address - Country:US
Practice Address - Phone:410-474-1765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty