Provider Demographics
NPI:1750058244
Name:MIND 247 PRACTICE LLC
Entity type:Organization
Organization Name:MIND 247 PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPALKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-248-6338
Mailing Address - Street 1:1465 N SCOTTSDALE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3634
Mailing Address - Country:US
Mailing Address - Phone:844-646-3247
Mailing Address - Fax:
Practice Address - Street 1:1138 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3000
Practice Address - Country:US
Practice Address - Phone:844-248-6338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)