| Heart Mind Center, Llc | |
|
28 Windmill Rd Edgewood NM 87015-6918 | |
| (505) 288-7025 | |
| Not Available |
| Full Name | Heart Mind Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 28 Windmill Rd, Edgewood, New Mexico |
| Authorized Official Name and Position | Melissa A Wolf (CLINICAL COUNSELOR/DIRECTOR) |
| Authorized Official Contact | 5052887025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart Mind Center, Llc 28 Windmill Road Edgewood NM 87015-6918 Ph: (505) 288-7025 | Heart Mind Center, Llc 28 Windmill Rd Edgewood NM 87015-6918 Ph: (505) 288-7025 |
| NPI Number | 1073879813 |
|---|---|
| Provider Enumeration Date | 04/05/2012 |
| Last Update Date | 02/26/2024 |
| Medicare PECOS PAC ID | 7214373604 |
|---|---|
| Medicare Enrollment ID | O20240307002372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073879813 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 4887 (Idaho) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Melissa A Wolf |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275772600 PECOS PAC ID: 2769828151 Enrollment ID: I20240307002752 |
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