Provider Demographics
NPI:1801462999
Name:MINDWISE PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:MINDWISE PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GYURJYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-333-2027
Mailing Address - Street 1:3525 DEL MAR HEIGHTS RD # 1961
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2199
Mailing Address - Country:US
Mailing Address - Phone:858-333-2027
Mailing Address - Fax:
Practice Address - Street 1:3645 RUFFIN RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1845
Practice Address - Country:US
Practice Address - Phone:858-333-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty