NPIMap

Organization Active NPI

Mending Minds Wellness Center

  • Clinical Social Worker
  • Largo, MD
National Provider Identifier
1114584091
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MENDING MINDS WELLNESS CENTER
Practice address
1401 Mercantile Lane
Suite 485
Largo, MD 20774-2005
Phone
(301) 615-1911
NPI assigned
May 25, 2019
Last updated
Aug 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jene Colette Gould, LCSW-CNPI 1114334893
Title
Psyhotherapist
Phone
(301) 615-1911

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

1401 Mercantile Lane
Suite 485
Largo, MD 20774-2005

Mailing address

12138 Central Ave Ste 937
Mitchellville, MD 20721-1910
Phone (240) 484-7112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190927001168 DC Part B Supplier - Clinic/Group Practice 6204166697 Receives reassigned benefits from 1 practitioner
Practice locations: Bowie, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1114584091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12138 CENTRAL AVE STE 937",
            "city": "MITCHELLVILLE",
            "state": "MD",
            "postal_code": "207211910",
            "telephone_number": "240-484-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MERCANTILE LANE",
            "address_2": "SUITE 485",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207742005",
            "telephone_number": "301-615-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDING MINDS WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-25",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "JENE",
        "authorized_official_middle_name": "COLETTE",
        "authorized_official_title_or_position": "PSYHOTHERAPIST",
        "authorized_official_telephone_number": "301-615-1911",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.