Mind Revolution Services LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MIND REVOLUTION SERVICES LLC

Practice address

1800 E Main St
Richmond, VA 23223-6962

Phone

(703) 628-0705

NPI assigned

Jun 19, 2023

Last updated

Jun 21, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tysean Markeal Ford

Title

President

Phone

(703) 628-0705

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1801571872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 E MAIN ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232236962",
            "telephone_number": "703-628-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E MAIN ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232236962",
            "telephone_number": "703-628-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REVOLUTION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "TYSEAN",
        "authorized_official_middle_name": "MARKEAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-628-0705"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Richmond, VA
• Providers in Richmond, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.