Provider Demographics
NPI:1801484712
Name:MINDCALM PSYCHIATRIC & BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MINDCALM PSYCHIATRIC & BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:505-395-4690
Mailing Address - Street 1:PO BOX 271322
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-1322
Mailing Address - Country:US
Mailing Address - Phone:505-395-4690
Mailing Address - Fax:978-378-2056
Practice Address - Street 1:150 WASHINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2038
Practice Address - Country:US
Practice Address - Phone:505-395-4690
Practice Address - Fax:978-378-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty