Provider Demographics
NPI:1114728797
Name:MINDWAY BEHAVIORAL PLLC
Entity type:Organization
Organization Name:MINDWAY BEHAVIORAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ADEDEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAJIDE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:682-554-4083
Mailing Address - Street 1:912 RIDGEHURST CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2370
Mailing Address - Country:US
Mailing Address - Phone:682-554-4083
Mailing Address - Fax:
Practice Address - Street 1:912 RIDGEHURST CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2370
Practice Address - Country:US
Practice Address - Phone:682-554-4083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center