1Derfull Minds, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

1DERFULL MINDS, INC.

Practice address

631 Cresent Dr
Desoto, TX 75115-8017

Phone

(469) 235-2390

Fax

(972) 637-7576

NPI assigned

Oct 25, 2021

Organization subpart

No

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

Authorized official

Name

Ella Marie Miles, BBA, LVNNPI 1750708152

Title

President/Program Manager

Phone

(469) 235-2390

Specialties & licenses 1

Addresses

Other names 1

• 1DERFULL MINDS Doing business as

Practitioners 1

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

• Ella Marie Miles, L.V.N.,B.B.A.

  • Community Health Worker
  • Desoto, TX
  • NPI 1750708152
  NPD Authorized official

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1487318671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 CRESENT DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158017",
            "telephone_number": "469-235-2390",
            "fax_number": "972-637-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 CRESENT DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158017",
            "telephone_number": "469-235-2390",
            "fax_number": "972-637-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1DERFULL MINDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-25",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "ELLA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT/PROGRAM MANAGER",
        "authorized_official_telephone_number": "469-235-2390",
        "authorized_official_credential": "BBA, LVN"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1DERFULL MINDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Desoto, TX
• Community/Behavioral Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.