| Mind & Soul Telewellness Llc | |
|
1430 Reisterstown Rd Ste 3 Pikesville MD 21208-3843 | |
| (443) 953-8922 | |
| (855) 955-1334 |
| Full Name | Mind & Soul Telewellness Llc |
|---|---|
| Speciality | Counselor |
| Location | 1430 Reisterstown Rd Ste 3, Pikesville, Maryland |
| Authorized Official Name and Position | Toni Ray (DIRECTOR) |
| Authorized Official Contact | 4439538922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind & Soul Telewellness Llc 1430 Reisterstown Rd Ste 3 Pikesville MD 21208-3843 Ph: (443) 972-0178 | Mind & Soul Telewellness Llc 1430 Reisterstown Rd Ste 3 Pikesville MD 21208-3843 Ph: (443) 953-8922 |
| NPI Number | 1205495496 |
|---|---|
| Provider Enumeration Date | 06/11/2019 |
| Last Update Date | 12/11/2020 |
| Certification Date | 12/11/2020 |
| Medicare PECOS PAC ID | 8123350576 |
|---|---|
| Medicare Enrollment ID | O20191104003125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205495496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gretchen Ryle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972048593 PECOS PAC ID: 5092083816 Enrollment ID: I20170621000033 |
| Provider Name | Glory Forbi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790310506 PECOS PAC ID: 7012338775 Enrollment ID: I20200612001569 |
| Provider Name | Nakeia Newton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992317846 PECOS PAC ID: 3870904485 Enrollment ID: I20201202001635 |
| Provider Name | Tiera York Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679928204 PECOS PAC ID: 7618389776 Enrollment ID: I20201214001615 |
| Provider Name | Lacresha Reid White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821446956 PECOS PAC ID: 1456757533 Enrollment ID: I20210915002496 |
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