| NPI | 1730745076 |
|---|---|
| Doing Business As | KINTSUGI MIND SPA |
| Entity Type | Organization |
| Authorized Contact | TATYANA ELLISON Medical Director 949-500-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 163W00000X Registered Nurse | |
| 171100000X Acupuncturist | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 225700000X Massage Therapist | |
| 225X00000X Occupational Therapist | |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2019-05-13 |