Modern Mind & Wellness LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MODERN MIND & WELLNESS LLC

Practice address

8301 Lakeview Pkwy Ste 111-138
Rowlett, TX 75088-9320

Phone

(817) 707-6024

NPI assigned

Aug 29, 2019

Last updated

Aug 29, 2019By 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

Fantasia Harris, APRN, FNP, PMHNP

Title

Administrator

Phone

(817) 707-6024

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567036800000",
    "number": "1942858303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8301 LAKEVIEW PKWY STE 111-138",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750889320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8301 LAKEVIEW PKWY STE 111-138",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750889320",
            "telephone_number": "817-707-6024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MIND & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-29",
        "last_updated": "2019-08-29",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "FANTASIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-707-6024",
        "authorized_official_credential": "APRN, FNP, PMHNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Mitchell-Ibe, LMSW
• Crystal Mitchell
• Taya Mitchell
• Tamanna Mithani, DO
• Michael Mixon
• Karen Molina, DC
• Edwin Joseph Mones, PT
• Emma Rose Monroe
• Megan P Monroe
• Melissa Montez

• Clinic/Center in Rowlett, TX
• Providers in Rowlett, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; 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.