NPI | 1366105199 |
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Doing Business As | MIND MED MENTAL HEALTH |
Former Legal Business Name | VIRTUAL VISIT LLC |
Entity Type | Organization |
Authorized Contact | CAMILLE ELLEN PINCOCK Owner 208-720-3948 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
Additional Taxonomies | 207Q00000X Family Medicine |
Enumeration Date | 2021-10-19 |
Last Update Date | 2024-12-18 |