| Pure Mind Works, Pllc | |
|
1608 W 17th St Bryan TX 77803-1504 | |
| (979) 739-4269 | |
| Not Available |
| Full Name | Pure Mind Works, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1608 W 17th St, Bryan, Texas |
| Authorized Official Name and Position | Ashley Nelson (THERAPIST) |
| Authorized Official Contact | 9797394269 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Mind Works, Pllc Po Box 2747 Bryan TX 77805-2747 Ph: (979) 739-4269 | Pure Mind Works, Pllc 1608 W 17th St Bryan TX 77803-1504 Ph: (979) 739-4269 |
| NPI Number | 1063297349 |
|---|---|
| Provider Enumeration Date | 08/25/2023 |
| Last Update Date | 08/25/2023 |
| Certification Date | 08/25/2023 |
| Medicare PECOS PAC ID | 8426490293 |
|---|---|
| Medicare Enrollment ID | O20240524000345 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063297349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Ashley Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124614805 PECOS PAC ID: 8426406695 Enrollment ID: I20231128003443 |
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