Provider Demographics
NPI:1972284669
Name:MINESET MENTAL HEALTH INC.
Entity Type:Organization
Organization Name:MINESET MENTAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:NICOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:310-737-2210
Mailing Address - Street 1:1840 S ELENA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5716
Mailing Address - Country:US
Mailing Address - Phone:310-737-2210
Mailing Address - Fax:
Practice Address - Street 1:1840 S ELENA AVE STE 106
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5716
Practice Address - Country:US
Practice Address - Phone:310-737-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)