Provider Demographics
NPI:1962244921
Name:NURTURING MINDS THERAPY CENTER, LLC
Entity type:Organization
Organization Name:NURTURING MINDS THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER AND CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-228-9048
Mailing Address - Street 1:6500 HALCYON WAY APT 471
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2380
Mailing Address - Country:US
Mailing Address - Phone:904-228-9048
Mailing Address - Fax:
Practice Address - Street 1:6500 HALCYON WAY APT 471
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2380
Practice Address - Country:US
Practice Address - Phone:904-228-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty