# MAGNIFICENT MINDS TELEMED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275255309
- **Authorized official:** DEMARCUS PATTERSON (OWNER)
- **Authorized official phone:** (504) 908-0715

## Contact information

- **Practice address:** 630 W CORNERVIEW ST STE B, GONZALES, LA 70737-2742
- **Practice address phone:** (225) 647-4105
- **Mailing address:** PO BOX 359, GONZALES, LA 70707-0359
- **Mailing address phone:** (504) 915-0705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/15/2022
- **Last updated:** 09/15/2022