Provider Demographics
NPI:1518591460
Name:MYND WORKS PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:MYND WORKS PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BOLLES
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:512-791-5433
Mailing Address - Street 1:3724 JEFFERSON ST STE 206
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6221
Mailing Address - Country:US
Mailing Address - Phone:512-739-6566
Mailing Address - Fax:254-651-1062
Practice Address - Street 1:3724 JEFFERSON ST STE 206
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6221
Practice Address - Country:US
Practice Address - Phone:512-739-6566
Practice Address - Fax:254-651-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty