Provider Demographics
NPI:1639701899
Name:A BEAUTIFUL MIND LLC
Entity Type:Organization
Organization Name:A BEAUTIFUL MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HIPSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:307-337-1173
Mailing Address - Street 1:145 S DURBIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2566
Mailing Address - Country:US
Mailing Address - Phone:307-337-1173
Mailing Address - Fax:307-337-1221
Practice Address - Street 1:145 S DURBIN ST STE 207
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2566
Practice Address - Country:US
Practice Address - Phone:307-337-1173
Practice Address - Fax:307-337-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty