Provider Demographics
NPI:1194414474
Name:MYND YOUR MENTAL ENTERPRISES
Entity type:Organization
Organization Name:MYND YOUR MENTAL ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:DEMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-291-8363
Mailing Address - Street 1:2717 COMMERCIAL CENTER BLVD STE E200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7823
Mailing Address - Country:US
Mailing Address - Phone:832-291-8363
Mailing Address - Fax:832-203-7115
Practice Address - Street 1:2717 COMMERCIAL CENTER BLVD STE E200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7823
Practice Address - Country:US
Practice Address - Phone:832-291-8363
Practice Address - Fax:832-203-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty