Provider Demographics
NPI:1255196903
Name:MINDWORKS PSYCHOLOGY GROUP
Entity type:Organization
Organization Name:MINDWORKS PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-363-5350
Mailing Address - Street 1:4145 W 131ST TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-4139
Mailing Address - Country:US
Mailing Address - Phone:619-363-5350
Mailing Address - Fax:
Practice Address - Street 1:4145 W 131ST TER
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-4139
Practice Address - Country:US
Practice Address - Phone:619-363-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)