Provider Demographics
NPI:1669176566
Name:MIND BY DESIGN WELLNESS CENTER, INC
Entity type:Organization
Organization Name:MIND BY DESIGN WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:760-308-2600
Mailing Address - Street 1:78000 FRED WARING DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9266
Mailing Address - Country:US
Mailing Address - Phone:760-308-2600
Mailing Address - Fax:
Practice Address - Street 1:78000 FRED WARING DR STE 102
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9266
Practice Address - Country:US
Practice Address - Phone:760-308-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health