Provider Demographics
NPI:1760921225
Name:A BEAUTIFUL MIND LLC
Entity Type:Organization
Organization Name:A BEAUTIFUL MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PHMNP
Authorized Official - Phone:601-953-7780
Mailing Address - Street 1:144 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4713
Mailing Address - Country:US
Mailing Address - Phone:601-953-7780
Mailing Address - Fax:
Practice Address - Street 1:1856 SMALLWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2521
Practice Address - Country:US
Practice Address - Phone:731-435-1545
Practice Address - Fax:877-600-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty