Provider Demographics
NPI:1225890262
Name:MINDWELL THERAPY GROUP
Entity Type:Organization
Organization Name:MINDWELL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:SHASHANA
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-682-5678
Mailing Address - Street 1:1075 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-3253
Mailing Address - Country:US
Mailing Address - Phone:443-682-5678
Mailing Address - Fax:
Practice Address - Street 1:1075 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-3253
Practice Address - Country:US
Practice Address - Phone:443-682-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty