Provider Demographics
NPI:1235992025
Name:OPEN MINDS HEALING CENTER
Entity Type:Organization
Organization Name:OPEN MINDS HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-772-6016
Mailing Address - Street 1:1750 W ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-9266
Mailing Address - Country:US
Mailing Address - Phone:480-772-6016
Mailing Address - Fax:
Practice Address - Street 1:4864 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4629
Practice Address - Country:US
Practice Address - Phone:480-863-6346
Practice Address - Fax:480-716-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)