Provider Demographics
NPI:1265104780
Name:MIND WORKS WELLNESS, PLLC
Entity type:Organization
Organization Name:MIND WORKS WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-530-5317
Mailing Address - Street 1:124 SUMMER ST STE D
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5918
Mailing Address - Country:US
Mailing Address - Phone:601-530-5317
Mailing Address - Fax:601-429-9195
Practice Address - Street 1:124 SUMMER ST STE D
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5918
Practice Address - Country:US
Practice Address - Phone:601-530-5317
Practice Address - Fax:601-429-9195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND WORKS WELLNESS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-03
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS007750897Medicaid