Provider Demographics
NPI:1912785445
Name:COLLABORATIVE MINDS THERAPY LLC
Entity Type:Organization
Organization Name:COLLABORATIVE MINDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-403-0875
Mailing Address - Street 1:217 SE 1ST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-2161
Mailing Address - Country:US
Mailing Address - Phone:352-403-0875
Mailing Address - Fax:352-309-6006
Practice Address - Street 1:217 SE 1ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2161
Practice Address - Country:US
Practice Address - Phone:352-403-0875
Practice Address - Fax:352-309-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty