Provider Demographics
NPI:1366131674
Name:MOOD & MIND PSYCHIATRY CARE SERVICES LLC
Entity type:Organization
Organization Name:MOOD & MIND PSYCHIATRY CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYODE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEMIMO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-515-1440
Mailing Address - Street 1:21357 N LILES LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-9573
Mailing Address - Country:US
Mailing Address - Phone:623-414-7715
Mailing Address - Fax:
Practice Address - Street 1:21357 N LILES LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-9573
Practice Address - Country:US
Practice Address - Phone:623-414-7715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty