Healthcare Provider Details

I. General information

NPI: 1750042263
Provider Name (Legal Business Name): CHANGING MINDSETS LTD COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 CROSS RD
PINE BLUFF AR
71603-9151
US

IV. Provider business mailing address

7700 CROSS RD
PINE BLUFF AR
71603-9151
US

V. Phone/Fax

Practice location:
  • Phone: 870-723-1703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHEENA GARRARD
Title or Position: OWNER
Credential:
Phone: 870-723-1703