Healthcare Provider Details

I. General information

NPI: 1578477220
Provider Name (Legal Business Name): MINDSET STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

V. Phone/Fax

Practice location:
  • Phone: 781-718-3956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIMOTHY COUGHLIN
Title or Position: OWNER
Credential: LCSW
Phone: 781-718-3956