Provider Demographics
NPI:1205486461
Name:MASTERMIND PSYCHOLOGY, P.S.
Entity type:Organization
Organization Name:MASTERMIND PSYCHOLOGY, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-474-1783
Mailing Address - Street 1:101 W CATALDO AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W CATALDO AVE STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3200
Practice Address - Country:US
Practice Address - Phone:509-474-1783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty