Provider Demographics
NPI:1720763774
Name:MENDED MINDS THERAPY, LLC
Entity Type:Organization
Organization Name:MENDED MINDS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-310-7874
Mailing Address - Street 1:6625 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9736
Mailing Address - Country:US
Mailing Address - Phone:301-580-6097
Mailing Address - Fax:
Practice Address - Street 1:13460 LONG DAYS CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MD
Practice Address - Zip Code:20777-9757
Practice Address - Country:US
Practice Address - Phone:301-310-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health