Provider Demographics
NPI:1962678441
Name:GREAT MINDS OF PUERTO RICO RESEARCHERS & CLINICAL PSYCHOLOGIST PSC
Entity Type:Organization
Organization Name:GREAT MINDS OF PUERTO RICO RESEARCHERS & CLINICAL PSYCHOLOGIST PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-579-6075
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0660
Mailing Address - Country:US
Mailing Address - Phone:787-579-6075
Mailing Address - Fax:
Practice Address - Street 1:URB GOLDEN HILL BO LAS CUEVAS
Practice Address - Street 2:SUITE 3
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977-0000
Practice Address - Country:US
Practice Address - Phone:787-579-6075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3058261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)