Provider Demographics
NPI:1245797091
Name:MINDTUNE LLC
Entity Type:Organization
Organization Name:MINDTUNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-837-8625
Mailing Address - Street 1:111 BANCROFT ST # 4421
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3674
Mailing Address - Country:US
Mailing Address - Phone:760-712-9817
Mailing Address - Fax:
Practice Address - Street 1:4305 GESNER ST STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6677
Practice Address - Country:US
Practice Address - Phone:619-586-9897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty