Organization
EMBOLDENED MIND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMBOLDENED WELLNESS THERAPEUTICS (AUTHORIZED OFFICIAL)
(937) 204-3505
Entity
Organization
Contact information
Practice address
318 REGENCY RIDGE DR, DAYTON, OH 45459-4251
(937) 204-3505
Mailing address
6254 WILMINGTON PIKE # 1011, CENTERVILLE, OH 45459-7020
(614) 323-0028
(606) 202-7598
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/30/2022
Last updated
04/12/2022
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