Provider Demographics
NPI:1821870916
Name:OPEN MINDS THERAPY
Entity Type:Organization
Organization Name:OPEN MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-751-2003
Mailing Address - Street 1:11 RIPTIDE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICA
Mailing Address - State:DE
Mailing Address - Zip Code:19946-2112
Mailing Address - Country:US
Mailing Address - Phone:302-751-2003
Mailing Address - Fax:
Practice Address - Street 1:11 RIPTIDE CT
Practice Address - Street 2:
Practice Address - City:FREDERICA
Practice Address - State:DE
Practice Address - Zip Code:19946-2112
Practice Address - Country:US
Practice Address - Phone:302-751-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty