Provider Demographics
NPI:1134908015
Name:MINDCHECK INC.
Entity type:Organization
Organization Name:MINDCHECK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:928-862-8689
Mailing Address - Street 1:3640 HIGHWAY 95 STE 120
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4336
Mailing Address - Country:US
Mailing Address - Phone:928-862-8689
Mailing Address - Fax:928-420-8950
Practice Address - Street 1:3640 HIGHWAY 95 STE 120
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4336
Practice Address - Country:US
Practice Address - Phone:928-862-8689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty