Provider Demographics
NPI:1700423472
Name:OPTIMAL MIND INSTITUTE
Entity Type:Organization
Organization Name:OPTIMAL MIND INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:PRILUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-765-3518
Mailing Address - Street 1:630 S. RAYMOND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3206
Mailing Address - Country:US
Mailing Address - Phone:626-765-3518
Mailing Address - Fax:626-765-3532
Practice Address - Street 1:630 S. RAYMOND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3206
Practice Address - Country:US
Practice Address - Phone:626-765-3518
Practice Address - Fax:626-765-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty