Provider Demographics
NPI:1720696586
Name:SOUND MIND PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:SOUND MIND PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-229-2747
Mailing Address - Street 1:110 MAIN ST STE 1201B
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3516
Mailing Address - Country:US
Mailing Address - Phone:207-229-2747
Mailing Address - Fax:207-517-5078
Practice Address - Street 1:110 MAIN ST STE 1201B
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3516
Practice Address - Country:US
Practice Address - Phone:207-229-2747
Practice Address - Fax:207-517-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty