Provider Demographics
NPI:1497252019
Name:DEVELOP MINDED THERAPIES
Entity Type:Organization
Organization Name:DEVELOP MINDED THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-750-2664
Mailing Address - Street 1:4040 S TYLER ST STE 9
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2143
Mailing Address - Country:US
Mailing Address - Phone:253-750-2664
Mailing Address - Fax:253-215-4426
Practice Address - Street 1:4040 S TYLER ST STE 9
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2143
Practice Address - Country:US
Practice Address - Phone:253-750-2664
Practice Address - Fax:253-215-4426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEVELOP MINDED THERAPIES (GENERAL)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-10
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty