Provider Demographics
NPI:1629601927
Name:MIND WORKS THERAPY PLLC
Entity Type:Organization
Organization Name:MIND WORKS THERAPY PLLC
Other - Org Name:MIND WORKS PSYCHOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:W
Authorized Official - Last Name:MONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:228-563-4006
Mailing Address - Street 1:24505 MARE POINT DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-3302
Mailing Address - Country:US
Mailing Address - Phone:228-300-8819
Mailing Address - Fax:
Practice Address - Street 1:213 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4309
Practice Address - Country:US
Practice Address - Phone:228-300-8819
Practice Address - Fax:601-401-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty