Provider Demographics
NPI:1841555406
Name:STIMULATING MINDS AUTISM CLINIC, LLC
Entity type:Organization
Organization Name:STIMULATING MINDS AUTISM CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-259-2802
Mailing Address - Street 1:6001 SEAGULL ST., NE
Mailing Address - Street 2:SUITE 202 B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-259-2802
Mailing Address - Fax:505-892-2380
Practice Address - Street 1:6001 SEAGULL ST., NE
Practice Address - Street 2:SUITE 202 B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-259-2802
Practice Address - Fax:505-892-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-078201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMA101958Medicare PIN