Provider Demographics
NPI:1740008358
Name:MINDFUL MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:MINDFUL MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TEMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP, FNP
Authorized Official - Phone:410-696-5142
Mailing Address - Street 1:PO BOX 6021
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-0021
Mailing Address - Country:US
Mailing Address - Phone:410-493-6754
Mailing Address - Fax:
Practice Address - Street 1:5457 TWIN KNOLLS RD STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3296
Practice Address - Country:US
Practice Address - Phone:410-696-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty