Provider Demographics
NPI:1790235422
Name:ACCESS MIND INSTITUTE
Entity Type:Organization
Organization Name:ACCESS MIND INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA
Authorized Official - Phone:949-257-3637
Mailing Address - Street 1:30101 TOWN CENTER DR STE 113
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5028
Mailing Address - Country:US
Mailing Address - Phone:949-257-3637
Mailing Address - Fax:
Practice Address - Street 1:30101 TOWN CENTER DR STE 113
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5028
Practice Address - Country:US
Practice Address - Phone:949-257-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care