Provider Demographics
NPI:1083461321
Name:MINDSCAPE PSYCHOLOGY LLC
Entity type:Organization
Organization Name:MINDSCAPE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. HILLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-240-8915
Mailing Address - Street 1:115 N MAIN ST #320
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1766
Mailing Address - Country:US
Mailing Address - Phone:269-240-8915
Mailing Address - Fax:
Practice Address - Street 1:8695 MEADOW LN
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1426
Practice Address - Country:US
Practice Address - Phone:269-240-8915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty