Provider Demographics
NPI:1578449559
Name:THE HEALTHY MIND CENTER
Entity type:Organization
Organization Name:THE HEALTHY MIND CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-780-1857
Mailing Address - Street 1:2631 SILVERTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7176
Mailing Address - Country:US
Mailing Address - Phone:240-780-1857
Mailing Address - Fax:
Practice Address - Street 1:205 E BENSON BLVD STE 313
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4019
Practice Address - Country:US
Practice Address - Phone:240-780-1857
Practice Address - Fax:240-780-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1578449559Medicaid