Organization Name: | MINDWIRE THERAPY, INC |
NPI Number: | 1780095968 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEXANDRA THEIS (CEO) |
Mailing Address: | 401 Corbett St Suite 460 Belleair |
State: | FL US |
Postal Code: | 337567309 |
Phone Number: | 7273866495 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2014 |
NPI Last Update Date: | 05/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH11558 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |