Provider Demographics
NPI:1194408906
Name:MIND & WELLNESS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MIND & WELLNESS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OLASUMBO
Authorized Official - Middle Name:T
Authorized Official - Last Name:AFILAKA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, BC PMHNP, BC
Authorized Official - Phone:302-981-8926
Mailing Address - Street 1:3201 E PIONEER PKWY STE 40B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5324
Mailing Address - Country:US
Mailing Address - Phone:302-981-8926
Mailing Address - Fax:
Practice Address - Street 1:3201 E PIONEER PKWY STE 40B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5324
Practice Address - Country:US
Practice Address - Phone:302-981-8926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty