Provider Demographics
NPI:1073265278
Name:ATHMINDSET LLC
Entity Type:Organization
Organization Name:ATHMINDSET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMII
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:510-206-6095
Mailing Address - Street 1:875 ISLAND DR STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6700
Mailing Address - Country:US
Mailing Address - Phone:510-206-6095
Mailing Address - Fax:
Practice Address - Street 1:1104 MARIANAS LN
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6831
Practice Address - Country:US
Practice Address - Phone:510-206-6095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty