# PROVISIONS2LIVE BEHAVIORAL HEALTH PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Mind, Body & Soul Behavioral Health PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073255055
- **Authorized official:** MRS. JENNIFER INEZ MCLEAN-RUSS MSN/NP (PMH-NP)
- **Authorized official phone:** (919) 390-1398

## Contact information

- **Practice address:** 3622 LYCKAN PKWY STE 4006, DURHAM, NC 27707-2566
- **Practice address phone:** (919) 390-1398
- **Practice address fax:** (919) 910-5668
- **Mailing address:** 3622 LYCKAN PKWY STE 4006, DURHAM, NC 27707-2566
- **Mailing address phone:** (919) 390-1398
- **Mailing address fax:** (919) 910-5668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |
| 364SP0808X | Psychiatric/Mental Health Clinical Nurse Specialist | — | NULL | Yes |
| 364SP0808X | Psychiatric/Mental Health Clinical Nurse Specialist | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2022
- **Last updated:** 08/28/2026