Provider Demographics
NPI:1639905839
Name:MINDCARE THERAPEUTIC SOLUTIONS
Entity type:Organization
Organization Name:MINDCARE THERAPEUTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMMIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARNESS SR.
Authorized Official - Suffix:I
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-319-2563
Mailing Address - Street 1:526 COUNTY ROAD 4711
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-5873
Mailing Address - Country:US
Mailing Address - Phone:254-319-2563
Mailing Address - Fax:
Practice Address - Street 1:526 COUNTY ROAD 4711
Practice Address - Street 2:
Practice Address - City:KEMPNER
Practice Address - State:TX
Practice Address - Zip Code:76539-5873
Practice Address - Country:US
Practice Address - Phone:254-319-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health