Provider Demographics
NPI:1265270839
Name:MIND2MIND REMEDIATION, LLC.
Entity type:Organization
Organization Name:MIND2MIND REMEDIATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:SKYLER
Authorized Official - Last Name:MCCREADY PHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:239-940-2481
Mailing Address - Street 1:5862 SANDBURG DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5835
Mailing Address - Country:US
Mailing Address - Phone:239-940-2481
Mailing Address - Fax:
Practice Address - Street 1:5862 SANDBURG DR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-5835
Practice Address - Country:US
Practice Address - Phone:239-940-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty