Provider Demographics
NPI:1033847694
Name:MINDSPOT COUNSELING, PLLC
Entity Type:Organization
Organization Name:MINDSPOT COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-538-2046
Mailing Address - Street 1:526 W 14TH ST # 132
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4051
Mailing Address - Country:US
Mailing Address - Phone:231-594-3023
Mailing Address - Fax:
Practice Address - Street 1:4833 SILVER PINES ROAD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685
Practice Address - Country:US
Practice Address - Phone:231-538-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336887223OtherNPI