Provider Demographics
NPI:1205578572
Name:MINDVISORY LLC
Entity type:Organization
Organization Name:MINDVISORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GICHEMA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:302-252-8498
Mailing Address - Street 1:802 VILLAGE CIR APT D
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4901
Mailing Address - Country:US
Mailing Address - Phone:302-252-8498
Mailing Address - Fax:
Practice Address - Street 1:802 VILLAGE CIR APT D
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4901
Practice Address - Country:US
Practice Address - Phone:302-252-8498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty