Provider Demographics
NPI:1235902818
Name:CULTURED MINDS
Entity Type:Organization
Organization Name:CULTURED MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IBN
Authorized Official - Middle Name:SHARIF
Authorized Official - Last Name:SHAKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-918-0531
Mailing Address - Street 1:10 MAIN ST APT 726
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3389
Mailing Address - Country:US
Mailing Address - Phone:201-918-0531
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST APT 726
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3389
Practice Address - Country:US
Practice Address - Phone:201-918-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty