Provider Demographics
NPI:1619472669
Name:MINDSCAPES BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MINDSCAPES BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, BCBA
Authorized Official - Phone:210-541-2860
Mailing Address - Street 1:101 PINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8842
Mailing Address - Country:US
Mailing Address - Phone:830-816-5510
Mailing Address - Fax:855-421-1717
Practice Address - Street 1:23910 W IH 10 APT 9205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1418
Practice Address - Country:US
Practice Address - Phone:210-541-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71038101YP2500X
1-15-18128103K00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty