Provider Demographics
NPI:1013637271
Name:MENDING MINDS COUNSELING AND CONSULTATION, LLC
Entity type:Organization
Organization Name:MENDING MINDS COUNSELING AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SHONTRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-674-5419
Mailing Address - Street 1:3102 KENNETH ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-4917
Mailing Address - Country:US
Mailing Address - Phone:901-674-5419
Mailing Address - Fax:
Practice Address - Street 1:312 N MISSOURI ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3186
Practice Address - Country:US
Practice Address - Phone:901-674-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)