Provider Demographics
NPI:1932847969
Name:MYND INTEGRATED LLC
Entity Type:Organization
Organization Name:MYND INTEGRATED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-205-1466
Mailing Address - Street 1:5704 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6555
Mailing Address - Country:US
Mailing Address - Phone:701-220-8714
Mailing Address - Fax:
Practice Address - Street 1:300 NP AVE N STE 210
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4871
Practice Address - Country:US
Practice Address - Phone:701-205-1466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty