Provider Demographics
NPI:1508589912
Name:MOGREN, MINDY MICHELLE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:MICHELLE
Last Name:MOGREN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027
Mailing Address - Country:US
Mailing Address - Phone:334-618-3302
Mailing Address - Fax:
Practice Address - Street 1:317 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027
Practice Address - Country:US
Practice Address - Phone:334-618-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL22-234268Other22-234268