Healthcare Provider Details

I. General information

NPI: 1417747072
Provider Name (Legal Business Name): ADAPTABILITY MINDSET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S GOLD CANYON ST
RIDGECREST CA
93555-4122
US

IV. Provider business mailing address

132 S GOLD CANYON ST
RIDGECREST CA
93555-4122
US

V. Phone/Fax

Practice location:
  • Phone: 661-917-6692
  • Fax:
Mailing address:
  • Phone: 661-917-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DIANA LOPEZ
Title or Position: CEO
Credential: BCBA
Phone: 661-917-6692