Magnificent Minds Telemed

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

MAGNIFICENT MINDS TELEMED

Practice address

630 W Cornerview St Ste B
Gonzales, LA 70737-2742

Phone

(225) 647-4105

NPI assigned

Sep 15, 2022

Organization subpart

No

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

Authorized official

Name

Demarcus PattersonNPI 1750827085

Title

Owner

Phone

(504) 908-0715

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Demarcus Patterson

  • Mental Health Counselor
  • Gonzales, LA
  • NPI 1750827085
  NPD Authorized official

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1275255309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 359",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707070359",
            "telephone_number": "504-915-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W CORNERVIEW ST STE B",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707372742",
            "telephone_number": "225-647-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNIFICENT MINDS TELEMED",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "DEMARCUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-908-0715"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anayt De Jesus Macias-Arredondo
• Sieda Marie Mackey, LPN
• Jenny Madere, FNP
• Margaret Madere, LCSW
• Valencia Fuller Magee
• Margaret D. Mahler, FNP-C
• Khanh Mai
• Kendra Durr Main, LCSW-BACS
• Parissa L Majlesein, PT, DPT
• Stephen Bernard Manale, M.D.

• Child & Adolescent Psychiatry Physician in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Child & Adolescent Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.