Provider Demographics
NPI:1598232548
Name:DIFFERENT MINDS LLC
Entity Type:Organization
Organization Name:DIFFERENT MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-572-7905
Mailing Address - Street 1:1110 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2505
Mailing Address - Country:US
Mailing Address - Phone:801-574-5074
Mailing Address - Fax:608-260-7204
Practice Address - Street 1:313 PRICE PL STE 109
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3262
Practice Address - Country:US
Practice Address - Phone:608-572-7905
Practice Address - Fax:608-260-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty