Provider Demographics
NPI:1144714882
Name:IMIND MENTAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:IMIND MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, PMHNP
Authorized Official - Phone:731-300-0810
Mailing Address - Street 1:168 W UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1624
Mailing Address - Country:US
Mailing Address - Phone:731-300-0810
Mailing Address - Fax:
Practice Address - Street 1:65 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3628
Practice Address - Country:US
Practice Address - Phone:731-363-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty