Provider Demographics
NPI:1649376443
Name:MIND OF THE ATHLETE, LLC
Entity type:Organization
Organization Name:MIND OF THE ATHLETE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-837-6616
Mailing Address - Street 1:3400 BATH PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2466
Mailing Address - Country:US
Mailing Address - Phone:610-867-7770
Mailing Address - Fax:610-867-7778
Practice Address - Street 1:3400 BATH PIKE
Practice Address - Street 2:SUITE 302
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2466
Practice Address - Country:US
Practice Address - Phone:610-867-7770
Practice Address - Fax:610-867-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015497103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty