Provider Demographics
NPI:1659126357
Name:MINDS OF GOLD
Entity Type:Organization
Organization Name:MINDS OF GOLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TONIKA
Authorized Official - Middle Name:LUDELL
Authorized Official - Last Name:LAFLORA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-469-5458
Mailing Address - Street 1:5301 ALPHA RD STE 80
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4393
Mailing Address - Country:US
Mailing Address - Phone:469-469-5458
Mailing Address - Fax:
Practice Address - Street 1:5301 ALPHA RD STE 80
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4393
Practice Address - Country:US
Practice Address - Phone:469-469-5458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty