Provider Demographics
NPI:1548838758
Name:CLEAR MINDS FAMILY AND MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CLEAR MINDS FAMILY AND MENTAL HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAKUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-580-4776
Mailing Address - Street 1:11140 ROCKVILLE PIKE STE 590A
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3183
Mailing Address - Country:US
Mailing Address - Phone:301-580-4776
Mailing Address - Fax:301-580-5192
Practice Address - Street 1:11140 ROCKVILLE PIKE STE 590A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3183
Practice Address - Country:US
Practice Address - Phone:301-580-4776
Practice Address - Fax:301-580-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1295329134OtherNPI
MD1548838768OtherIRS