Provider Demographics
NPI:1780629923
Name:HEARTS AND MINDS, INC.
Entity Type:Organization
Organization Name:HEARTS AND MINDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-944-0480
Mailing Address - Street 1:7220 N 16TH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5253
Mailing Address - Country:US
Mailing Address - Phone:602-944-0480
Mailing Address - Fax:602-944-0482
Practice Address - Street 1:7220 N 16TH ST
Practice Address - Street 2:SUITE G
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5253
Practice Address - Country:US
Practice Address - Phone:602-944-0480
Practice Address - Fax:602-944-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPHD856103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ732512001Medicaid
AZ107741Medicare ID - Type Unspecified
AZR03081Medicare UPIN