Provider Demographics
NPI:1346635349
Name:MINDS IN MOTION INTEGRATED BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MINDS IN MOTION INTEGRATED BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECIUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:302-743-5486
Mailing Address - Street 1:4142 OGLETOWN STANTON RD
Mailing Address - Street 2:MAILBOX 210
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4169
Mailing Address - Country:US
Mailing Address - Phone:302-743-5486
Mailing Address - Fax:
Practice Address - Street 1:4142 OGLETOWN STANTON RD
Practice Address - Street 2:MAILBOX 210
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4169
Practice Address - Country:US
Practice Address - Phone:302-743-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2015602352251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health