| Emboldened Mind Llc | |
|
318 Regency Ridge Dr Dayton OH 45459-4251 | |
| (937) 204-3505 | |
| Not Available |
| Full Name | Emboldened Mind Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 318 Regency Ridge Dr, Dayton, Ohio |
| Authorized Official Name and Position | Emboldened Wellness Therapeutics (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9372043505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emboldened Mind Llc 6254 Wilmington Pike # 1011 Centerville OH 45459-7020 Ph: (614) 323-0028 | Emboldened Mind Llc 318 Regency Ridge Dr Dayton OH 45459-4251 Ph: (937) 204-3505 |
| NPI Number | 1629718440 |
|---|---|
| Provider Enumeration Date | 03/30/2022 |
| Last Update Date | 04/12/2022 |
| Certification Date | 04/12/2022 |
| Medicare PECOS PAC ID | 5294103800 |
|---|---|
| Medicare Enrollment ID | O20221201001004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629718440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Erica A Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457570822 PECOS PAC ID: 6103181946 Enrollment ID: I20180529002547 |
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