Provider Demographics
NPI:1104550805
Name:MINDGROVE INCLUSIVE PSYCHOTHERAPEUTIC SERVICES, PLLC
Entity type:Organization
Organization Name:MINDGROVE INCLUSIVE PSYCHOTHERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMCSW, CAADC, MHP
Authorized Official - Phone:231-878-3053
Mailing Address - Street 1:1825 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9316
Mailing Address - Country:US
Mailing Address - Phone:231-878-3053
Mailing Address - Fax:
Practice Address - Street 1:1825 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9316
Practice Address - Country:US
Practice Address - Phone:231-878-3053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty