Provider Demographics
NPI:1689381121
Name:MINDWORKS BEHAVIORAL, PLLC
Entity Type:Organization
Organization Name:MINDWORKS BEHAVIORAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-319-3533
Mailing Address - Street 1:6424 E GREENWAY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2045
Mailing Address - Country:US
Mailing Address - Phone:480-319-3533
Mailing Address - Fax:
Practice Address - Street 1:6424 E GREENWAY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2045
Practice Address - Country:US
Practice Address - Phone:480-319-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health