Provider Demographics
NPI:1285236836
Name:REVITALIZING MINDS PROJECT
Entity type:Organization
Organization Name:REVITALIZING MINDS PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-896-5233
Mailing Address - Street 1:PO BOX 4871
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-1871
Mailing Address - Country:US
Mailing Address - Phone:310-896-5233
Mailing Address - Fax:
Practice Address - Street 1:31727 MULHOLLAND HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2704
Practice Address - Country:US
Practice Address - Phone:310-896-5233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health