Provider Demographics
NPI:1578372272
Name:MINDSPIRE LLC
Entity type:Organization
Organization Name:MINDSPIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:732-200-2421
Mailing Address - Street 1:6 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1252
Mailing Address - Country:US
Mailing Address - Phone:732-200-2421
Mailing Address - Fax:
Practice Address - Street 1:6 COTTONWOOD CT
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1252
Practice Address - Country:US
Practice Address - Phone:732-200-2421
Practice Address - Fax:704-839-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health