Provider Demographics
NPI:1649886151
Name:MIND PERCEPTION THERAPY
Entity type:Organization
Organization Name:MIND PERCEPTION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:BRADY-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:979-574-9568
Mailing Address - Street 1:4736 GRAND MASTERS WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5553
Mailing Address - Country:US
Mailing Address - Phone:979-574-9568
Mailing Address - Fax:
Practice Address - Street 1:4736 GRAND MASTERS WAY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5553
Practice Address - Country:US
Practice Address - Phone:979-574-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty