Provider Demographics
NPI:1740037860
Name:FLEXMIND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:FLEXMIND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:509-294-3154
Mailing Address - Street 1:3870 BROOKGREEN PT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5631
Mailing Address - Country:US
Mailing Address - Phone:509-294-3154
Mailing Address - Fax:
Practice Address - Street 1:3870 BROOKGREEN PT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5631
Practice Address - Country:US
Practice Address - Phone:509-294-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093256430Medicaid