Provider Demographics
NPI:1316777527
Name:INCLUSIVE MINDS, PLLC
Entity type:Organization
Organization Name:INCLUSIVE MINDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AYARZA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:210-749-5671
Mailing Address - Street 1:1486 PASEO DE ENCINAL DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6445
Mailing Address - Country:US
Mailing Address - Phone:210-749-5671
Mailing Address - Fax:
Practice Address - Street 1:1486 PASEO DE ENCINAL DR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6445
Practice Address - Country:US
Practice Address - Phone:210-749-5671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty