Provider Demographics
NPI:1538667415
Name:MINDWORKS CLINIC, PLLC
Entity Type:Organization
Organization Name:MINDWORKS CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:PRINCIPE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:801-923-6750
Mailing Address - Street 1:159 W BROADWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1923
Mailing Address - Country:US
Mailing Address - Phone:801-923-6750
Mailing Address - Fax:
Practice Address - Street 1:159 W BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1923
Practice Address - Country:US
Practice Address - Phone:801-923-6750
Practice Address - Fax:888-393-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10569210-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty