Provider Demographics
NPI:1073359287
Name:MINDSHIFT CONSULTING LLC
Entity type:Organization
Organization Name:MINDSHIFT CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTADINOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-316-9045
Mailing Address - Street 1:1079 N SPOEDE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5574
Mailing Address - Country:US
Mailing Address - Phone:929-316-9045
Mailing Address - Fax:
Practice Address - Street 1:1079 N SPOEDE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5574
Practice Address - Country:US
Practice Address - Phone:929-316-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty