Provider Demographics
NPI:1508433582
Name:MENTPHYS WELLNESS PLLC
Entity Type:Organization
Organization Name:MENTPHYS WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEARDSLEY-GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:919-397-0081
Mailing Address - Street 1:316 W MILLBROOK RD STE 209
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4482
Mailing Address - Country:US
Mailing Address - Phone:919-397-0081
Mailing Address - Fax:919-516-0072
Practice Address - Street 1:316 W MILLBROOK RD STE 209
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4482
Practice Address - Country:US
Practice Address - Phone:919-397-0081
Practice Address - Fax:919-516-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265945471OtherBLUE CROSS AND BLUE SHIELD OF NC
NC1265945471OtherMEDCOST