Provider Demographics
NPI:1912731688
Name:KAIZEN MIND PERFORMANCE SOLUTIONS
Entity type:Organization
Organization Name:KAIZEN MIND PERFORMANCE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-800-1969
Mailing Address - Street 1:7022 KNIGHTS HVN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3823
Mailing Address - Country:US
Mailing Address - Phone:830-356-6687
Mailing Address - Fax:
Practice Address - Street 1:7022 KNIGHTS HVN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-3823
Practice Address - Country:US
Practice Address - Phone:830-356-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty