Provider Demographics
NPI:1134684061
Name:OUT OF MIND,LLC
Entity Type:Organization
Organization Name:OUT OF MIND,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENISHA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,NCC
Authorized Official - Phone:313-522-2520
Mailing Address - Street 1:17649 KINGSBROOKE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3789
Mailing Address - Country:US
Mailing Address - Phone:313-522-5220
Mailing Address - Fax:
Practice Address - Street 1:39200 GARFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4095
Practice Address - Country:US
Practice Address - Phone:313-522-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1538502299OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE