| NPI | 1427351873 |
|---|---|
| Doing Business As | MIND SPA |
| Entity Type | Organization |
| Authorized Contact | SHERI JOLENE FLUELLEN CEO 307-509-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WY 498) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 3495) |
| 103TC0700X Psychologist, Clinical (Licence: WY 498) | |
| 103TC0700X Psychologist, Clinical (Licence: CO 3495) | |
| 103TC1900X Psychologist, Counseling (Licence: WY 498) | |
| 103TC1900X Psychologist, Counseling (Licence: CO 3495) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WY498) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: WY WY498) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WY 498) | |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2015-03-09 |