Provider Demographics
NPI:1295365922
Name:CHANGING MINDS, LLC
Entity Type:Organization
Organization Name:CHANGING MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:228-463-2680
Mailing Address - Street 1:835 HIGHWAY 90 STE 12
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1607
Mailing Address - Country:US
Mailing Address - Phone:228-463-2680
Mailing Address - Fax:
Practice Address - Street 1:835 HIGHWAY 90 STE 12
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1607
Practice Address - Country:US
Practice Address - Phone:228-463-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health