Provider Demographics
NPI:1700523693
Name:SOUND MIND HOLISTIC SERVICES LLC
Entity Type:Organization
Organization Name:SOUND MIND HOLISTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NZIMA JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-874-0159
Mailing Address - Street 1:4500 MERCANTILE PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4206
Mailing Address - Country:US
Mailing Address - Phone:817-874-0159
Mailing Address - Fax:
Practice Address - Street 1:4500 MERCANTILE PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4206
Practice Address - Country:US
Practice Address - Phone:817-874-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty