Provider Demographics
NPI:1659875813
Name:MINDY MAXWELL CLINICAL SERVICES PLLC
Entity Type:Organization
Organization Name:MINDY MAXWELL CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-402-8388
Mailing Address - Street 1:652 SW 150TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-4613
Mailing Address - Country:US
Mailing Address - Phone:415-903-0452
Mailing Address - Fax:
Practice Address - Street 1:652 SW 150TH ST APT A
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-4613
Practice Address - Country:US
Practice Address - Phone:415-903-0452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00009158OtherLMHC