Provider Demographics
NPI:1184413023
Name:SERENITY HEALTHY MINDS AND TELEMEDICINE WELLNESS
Entity type:Organization
Organization Name:SERENITY HEALTHY MINDS AND TELEMEDICINE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFUNKE-ROCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-979-8273
Mailing Address - Street 1:24871 S ELLSWORTH RD
Mailing Address - Street 2:STE 100 PMB 146
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24871 S ELLSWORTH RD
Practice Address - Street 2:STE 100 PMB 146
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-979-8273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty