Organization
MYNDFIT MENTAL HEALTH, LLC
Active
Other names
Myndfit
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLTON THOMAS FAIRLEY JR. QMHP-CS (OWNER/CHIEF EXECUTIVE OFFICER)
(210) 665-3330
Entity
Organization
Contact information
Practice address
13423 CORAM PEAK ST, SAN ANTONIO, TX 78248-1201
(210) 665-3330
Mailing address
13423 CORAM PEAK ST, SAN ANTONIO, TX 78248-1201
(210) 665-3330
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
302F00000X
Exclusive Provider Organization
Primary
—
—
305R00000X
Preferred Provider Organization
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
Other
Enumeration date
03/06/2024
Last updated
03/20/2024
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