Provider Demographics
NPI:1649085770
Name:AGILE MINDS THERAPY
Entity type:Organization
Organization Name:AGILE MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CMPC
Authorized Official - Phone:207-577-6360
Mailing Address - Street 1:41 CASTLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4079
Mailing Address - Country:US
Mailing Address - Phone:207-577-6360
Mailing Address - Fax:
Practice Address - Street 1:41 CASTLE ROCK RD
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4079
Practice Address - Country:US
Practice Address - Phone:207-577-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty