Organization
MINDBRANCH MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALLACE DALE FOX JR. APRN (OWNER)
(812) 946-2674
Entity
Organization
Contact information
Practice address
1400 MAIN ST UNIT 177, CLARKSVILLE, IN 47129-3108
(812) 946-2674
(844) 832-9625
Mailing address
1400 MAIN ST UNIT 177, CLARKSVILLE, IN 47129-3108
(812) 946-2674
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/25/2023
Last updated
12/19/2023
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