Provider Demographics
NPI:1093439655
Name:SOUND MINDS LLC
Entity type:Organization
Organization Name:SOUND MINDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCH NURES PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:FANDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:307-212-1042
Mailing Address - Street 1:1471 DEWAR DR STE 127
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5815
Mailing Address - Country:US
Mailing Address - Phone:307-630-3466
Mailing Address - Fax:
Practice Address - Street 1:1370 S WEST TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5218
Practice Address - Country:US
Practice Address - Phone:801-893-8417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty