Provider Demographics
NPI:1396497590
Name:THE MANE MISSION
Entity type:Organization
Organization Name:THE MANE MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:HULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-531-6470
Mailing Address - Street 1:3658 N PERRY PARK RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-8601
Mailing Address - Country:US
Mailing Address - Phone:970-531-6470
Mailing Address - Fax:
Practice Address - Street 1:3658 N PERRY PARK RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:CO
Practice Address - Zip Code:80135-8601
Practice Address - Country:US
Practice Address - Phone:970-531-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty