Provider Demographics
NPI:1619403631
Name:MINDWISE CORPORATION
Entity Type:Organization
Organization Name:MINDWISE CORPORATION
Other - Org Name:MINDWISE INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, RRT, MIACN
Authorized Official - Phone:970-319-1999
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-0556
Mailing Address - Country:US
Mailing Address - Phone:970-319-1999
Mailing Address - Fax:970-550-7555
Practice Address - Street 1:386 W MAIN STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647
Practice Address - Country:US
Practice Address - Phone:970-319-1999
Practice Address - Fax:970-319-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty