Provider Demographics
NPI:1477282002
Name:MASTER MINDS DYSLEXIA CENTER, LLC
Entity Type:Organization
Organization Name:MASTER MINDS DYSLEXIA CENTER, LLC
Other - Org Name:MASTER MINDS DYSLEXIA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER, SLP
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:662-643-3619
Mailing Address - Street 1:1630 GOODMAN RD E STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9556
Mailing Address - Country:US
Mailing Address - Phone:662-782-5330
Mailing Address - Fax:662-782-5329
Practice Address - Street 1:1630 GOODMAN RD E STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9556
Practice Address - Country:US
Practice Address - Phone:662-782-5330
Practice Address - Fax:662-782-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty