Provider Demographics
NPI:1306429600
Name:AUTHENTIC & INTENTIONAL MINDS, PLLC
Entity type:Organization
Organization Name:AUTHENTIC & INTENTIONAL MINDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:682-302-1338
Mailing Address - Street 1:10011 STONELAKE BLVD APT 366
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6097
Mailing Address - Country:US
Mailing Address - Phone:682-302-1338
Mailing Address - Fax:
Practice Address - Street 1:10011 STONELAKE BLVD APT 366
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6097
Practice Address - Country:US
Practice Address - Phone:682-302-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health