Provider Demographics
NPI:1245744671
Name:MYND HEALTH LLC
Entity Type:Organization
Organization Name:MYND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:843-839-2140
Mailing Address - Street 1:PO BOX 2881
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2665
Mailing Address - Country:US
Mailing Address - Phone:843-839-2140
Mailing Address - Fax:843-443-4229
Practice Address - Street 1:1012 16TH AVE NW STE 127
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-5285
Practice Address - Country:US
Practice Address - Phone:843-839-2140
Practice Address - Fax:843-443-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLCSW11977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty