Provider Demographics
NPI:1124678099
Name:INTEGRATED MINDSETS INC
Entity type:Organization
Organization Name:INTEGRATED MINDSETS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODSKY VERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-953-4744
Mailing Address - Street 1:1827 POWERS FERRY RD SE BLDG 22
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5621
Mailing Address - Country:US
Mailing Address - Phone:770-953-4744
Mailing Address - Fax:
Practice Address - Street 1:3860 WINDERMERE PKWY STE 203
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7034
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC003680OtherLICENSE