Provider Demographics
NPI:1932843984
Name:HEALTHY MIND HEALTHY LIFE
Entity Type:Organization
Organization Name:HEALTHY MIND HEALTHY LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C, PMHNP-BC
Authorized Official - Phone:248-963-8189
Mailing Address - Street 1:17515 W 9 MILE RD STE 650
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4403
Mailing Address - Country:US
Mailing Address - Phone:313-633-8385
Mailing Address - Fax:763-402-7611
Practice Address - Street 1:17515 W 9 MILE RD STE 650
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4403
Practice Address - Country:US
Practice Address - Phone:248-963-8189
Practice Address - Fax:763-402-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)