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Organization
MINDFUL HAVEN LLC
Active
Organization
MINDFUL HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTLE BROWN (BILLING MANAGER)
(410) 870-9380
Entity
Organization
Contact information
Practice address
9706 BELAIR RD # 101-102, NOTTINGHAM, MD 21236-1108
(410) 630-8292
Mailing address
5004 HONEYGO CENTER DR STE 102-294, PERRY HALL, MD 21128-8963
(410) 870-9380
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/09/2024
Last updated
08/15/2024
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