Provider Demographics
NPI:1629663620
Name:VIBRANT MINDS THERAPY & CONSULTING LLC
Entity Type:Organization
Organization Name:VIBRANT MINDS THERAPY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-242-1441
Mailing Address - Street 1:820 JORDAN ST STE 509
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4526
Mailing Address - Country:US
Mailing Address - Phone:318-242-1441
Mailing Address - Fax:318-300-1130
Practice Address - Street 1:820 JORDAN ST STE 509
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4526
Practice Address - Country:US
Practice Address - Phone:318-242-1441
Practice Address - Fax:318-300-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty