Healthcare Provider Details

I. General information

NPI: 1437623840
Provider Name (Legal Business Name): MIGHTY MINDS PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 UNION ST STE 4
SAN FRANCISCO CA
94123-4117
US

IV. Provider business mailing address

2088 UNION ST STE 4
SAN FRANCISCO CA
94123-4117
US

V. Phone/Fax

Practice location:
  • Phone: 415-780-3239
  • Fax:
Mailing address:
  • Phone: 415-780-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NINA KAISER
Title or Position: OWNER/CEO
Credential: PHD
Phone: 415-271-3245