Provider Demographics
NPI:1083325914
Name:CODE 3 MIND HEALTH, INC.
Entity Type:Organization
Organization Name:CODE 3 MIND HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIELESCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-841-7057
Mailing Address - Street 1:1315 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3906
Mailing Address - Country:US
Mailing Address - Phone:707-841-7057
Mailing Address - Fax:844-244-9422
Practice Address - Street 1:1315 CEDAR ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3906
Practice Address - Country:US
Practice Address - Phone:707-841-7057
Practice Address - Fax:844-244-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty