Organization
MODERN MIND & WELLNESS LLC
Active
Organization
MODERN MIND & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FANTASIA HARRIS APRN, FNP, PMHNP (ADMINISTRATOR)
(817) 707-6024
Entity
Organization
Contact information
Practice address
8301 LAKEVIEW PKWY STE 111-138, ROWLETT, TX 75088-9320
(817) 707-6024
Mailing address
8301 LAKEVIEW PKWY STE 111-138, ROWLETT, TX 75088-9320
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/29/2019
Last updated
08/29/2019
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