Provider Demographics
NPI:1699973628
Name:MIND CLINIC INC
Entity type:Organization
Organization Name:MIND CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESICENT
Authorized Official - Prefix:
Authorized Official - First Name:YASIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-354-6463
Mailing Address - Street 1:PO BOX 8323
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-8323
Mailing Address - Country:US
Mailing Address - Phone:480-354-6463
Mailing Address - Fax:480-354-6480
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3316
Practice Address - Country:US
Practice Address - Phone:480-354-6463
Practice Address - Fax:480-354-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1376151-0OtherCORPORATION NUMBER