Provider Demographics
NPI:1598468977
Name:MIND GROVE THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:MIND GROVE THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:RAJZER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-808-1344
Mailing Address - Street 1:70259 46TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-9154
Mailing Address - Country:US
Mailing Address - Phone:269-808-1344
Mailing Address - Fax:
Practice Address - Street 1:70259 46TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-9154
Practice Address - Country:US
Practice Address - Phone:269-808-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty