Provider Demographics
NPI:1356177612
Name:MERRY MIND WELLNESS, LLC
Entity type:Organization
Organization Name:MERRY MIND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, PMHNP-BC
Authorized Official - Phone:610-500-6355
Mailing Address - Street 1:53 DARBY RD STE Z
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1472
Mailing Address - Country:US
Mailing Address - Phone:610-500-6355
Mailing Address - Fax:252-300-3738
Practice Address - Street 1:53 DARBY RD STE Z
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1472
Practice Address - Country:US
Practice Address - Phone:201-657-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health