Mindbranch Mental Health Services

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MINDBRANCH MENTAL HEALTH SERVICES

Practice address

1400 Main St Unit 177
Clarksville, IN 47129-3108

Phone

(812) 946-2674

Fax

(844) 832-9625

NPI assigned

Sep 25, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Wallace Dale Fox Jr., APRN

Title

Owner

Phone

(812) 946-2674

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702944000000",
    "number": "1801675491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST UNIT 177",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471293108",
            "telephone_number": "812-946-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST UNIT 177",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471293108",
            "telephone_number": "812-946-2674",
            "fax_number": "844-832-9625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBRANCH MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-946-2674",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Miles
• Bailey Miller, M.S. CCC-SLP
• Katlynn Miller
• Linda Penrod Million, DOCTOR OF MINISTRY L
• Zaria Mills
• Ashley Miranda
• Tylar Mitchell
• Sydney Moler
• Emily Monsma, D.M.D
• Mallori Moody

• Psychiatric/Mental Health Nurse Practitioner in Clarksville, IN
• Providers in Clarksville, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.