Provider Demographics
NPI:1689034167
Name:MENDING MINDS MENDING HEARTS
Entity Type:Organization
Organization Name:MENDING MINDS MENDING HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:916-960-7795
Mailing Address - Street 1:1500 W EL CAMINO AVE
Mailing Address - Street 2:464
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1945
Mailing Address - Country:US
Mailing Address - Phone:916-960-7795
Mailing Address - Fax:
Practice Address - Street 1:6524 44TH ST
Practice Address - Street 2:208
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1265
Practice Address - Country:US
Practice Address - Phone:916-960-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty