Provider Demographics
NPI:1093555419
Name:INNOVATIVE MINDS
Entity type:Organization
Organization Name:INNOVATIVE MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OCEGUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-218-1849
Mailing Address - Street 1:2160 W 1465 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6788
Mailing Address - Country:US
Mailing Address - Phone:435-218-1849
Mailing Address - Fax:
Practice Address - Street 1:2160 W 1465 N
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6788
Practice Address - Country:US
Practice Address - Phone:435-218-1849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty