Provider Demographics
NPI:1770856320
Name:NURTURED MINDS, LLC
Entity Type:Organization
Organization Name:NURTURED MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMORY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-379-6879
Mailing Address - Street 1:3322 W CAMELOT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2182
Mailing Address - Country:US
Mailing Address - Phone:417-379-6879
Mailing Address - Fax:
Practice Address - Street 1:3322 W CAMELOT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2182
Practice Address - Country:US
Practice Address - Phone:417-379-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty