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Organization
PROVISIONS2LIVE BEHAVIORAL HEALTH PLLC
Active
Organization
PROVISIONS2LIVE BEHAVIORAL HEALTH PLLC
Active
Other names
Mind, Body & Soul Behavioral Health PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER INEZ MCLEAN-RUSS MSN/NP (PMH-NP)
(919) 390-1398
Entity
Organization
Contact information
Practice address
3622 LYCKAN PKWY STE 4006, DURHAM, NC 27707-2566
(919) 390-1398
(919) 910-5668
Mailing address
3622 LYCKAN PKWY STE 4006, DURHAM, NC 27707-2566
(919) 390-1398
(919) 910-5668
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
—
NULL
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
08/28/2026
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