Provider Demographics
NPI:1720858301
Name:MODERN MINDWORK, LLC
Entity Type:Organization
Organization Name:MODERN MINDWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN CRNA ARNP
Authorized Official - Phone:509-405-1001
Mailing Address - Street 1:1313 E MAPLE ST # 107
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5708
Mailing Address - Country:US
Mailing Address - Phone:509-405-1001
Mailing Address - Fax:
Practice Address - Street 1:1313 E MAPLE ST # 107
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5708
Practice Address - Country:US
Practice Address - Phone:509-405-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health