Provider Demographics
NPI:1821806605
Name:CHANGE MINDSET
Entity type:Organization
Organization Name:CHANGE MINDSET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / BCHHP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOTTE- OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:BCHHP, CHN
Authorized Official - Phone:973-517-0182
Mailing Address - Street 1:2232 DELL RANGE BLVD SUITE 245 BOX# 3317
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2232 DELL RANGE BLVD SUITE 245 BOX# 3317
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009
Practice Address - Country:US
Practice Address - Phone:973-517-0182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty