Provider Demographics
NPI:1720800667
Name:MIND SPACE MENTAL HEALTH INC
Entity type:Organization
Organization Name:MIND SPACE MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TUAN-TU SONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-689-9754
Mailing Address - Street 1:31852 COAST HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6767
Mailing Address - Country:US
Mailing Address - Phone:949-689-9754
Mailing Address - Fax:
Practice Address - Street 1:31852 COAST HWY STE 400
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6767
Practice Address - Country:US
Practice Address - Phone:949-689-9754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty