Mending Minds Mental Health Services LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

MENDING MINDS MENTAL HEALTH SERVICES LLC

Practice address

4445 Corporation LN Ste 264
Virginia Beach, VA 23462-3671

Phone

(813) 997-2099

NPI assigned

Aug 21, 2023

Organization subpart

No

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

Authorized official

Name

Brian Clukie

Title

Administrator

Phone

(813) 997-2099

Specialties & licenses 1

Addresses

Other names 1

• Mending Minds Mental Health Services LLC Former legal business name

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1790569085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 264",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 264",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623671",
            "telephone_number": "813-997-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDING MINDS MENTAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "CLUKIE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-997-2099"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mending Minds Mental Health Services LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mending Minds Mental Health Services LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• William Memery, DPT
• Maryah Celeste Mena
• Howard A Mendelsohn, D.D.S.
• Anna Kathryn Mendelson
• Moss H Mendelson, MD
• Mending Wellness, LLC
• Esperanza Mendiola Govea
• Michelle Mendiola-Vidal, PT, DPT
• Rachael W Mendivil, DPT
• David B Mendoza, DPT

• Psychiatry Physician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.