Provider Demographics
NPI:1407623663
Name:MINDSET TACOMA LLC
Entity Type:Organization
Organization Name:MINDSET TACOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEELBORG
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-320-5844
Mailing Address - Street 1:4240 MEMORY LN W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1125
Mailing Address - Country:US
Mailing Address - Phone:253-320-5844
Mailing Address - Fax:888-959-9016
Practice Address - Street 1:2302 S UNION AVE STE C26
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1334
Practice Address - Country:US
Practice Address - Phone:253-320-5844
Practice Address - Fax:888-949-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty