Provider Demographics
NPI:1285206250
Name:MIND HAVEN BEHAVIORAL CLINIC LLC
Entity type:Organization
Organization Name:MIND HAVEN BEHAVIORAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NONYE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:NWOKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-210-5592
Mailing Address - Street 1:733 HIGHWAY 287 N STE 407
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3867
Mailing Address - Country:US
Mailing Address - Phone:214-210-5592
Mailing Address - Fax:505-212-1939
Practice Address - Street 1:733 HIGHWAY 287 N STE 407
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3867
Practice Address - Country:US
Practice Address - Phone:214-210-5592
Practice Address - Fax:505-212-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-10
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty