Provider Demographics
NPI:1992429666
Name:FITMIND MENTAL HEALTH PRACTICE, LLC
Entity type:Organization
Organization Name:FITMIND MENTAL HEALTH PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:SHULAMMITE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:513-858-2732
Mailing Address - Street 1:5759 GLEN ABBY CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1244 NILLES RD STE 10
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2788
Practice Address - Country:US
Practice Address - Phone:513-858-2732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty