Organization
1DERFULL MINDS, INC.
Active
Other names
1DERFULL MINDS
Organization subpart
No
Provider details
NPI number
Authorized official
ELLA MARIE MILES BBA, LVN (PRESIDENT/PROGRAM MANAGER)
(469) 235-2390
Entity
Organization
Contact information
Practice address
631 CRESENT DR, DESOTO, TX 75115-8017
(469) 235-2390
(972) 637-7576
Mailing address
631 CRESENT DR, DESOTO, TX 75115-8017
(469) 235-2390
(972) 637-7576
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/25/2021
Last updated
09/29/2023
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