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1194683250 NPI number — LIFTED MINDS FAMILY SERVICES

NPI Number: 1194683250
Health Care Provider/Practitioner: LIFTED MINDS FAMILY SERVICES

Information about “1194683250” NPI (LIFTED MINDS FAMILY SERVICES) exists in 1194683250 in HTML format HTML  |  1194683250 in plain Text format TXT  |  1194683250 in PDF (Portable Document Format) PDF  |  1194683250 in an XML format XML  formats.

NPI Number : 1194683250 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194683250",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LIFTED MINDS FAMILY SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3626 NORTH HALL STREET (TWO OAK LAWN)",
    "SecondLineMailingAddress": "SUITE 610-N21",
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75219",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-904-0042",
    "MailingAddressFaxNumber": "469-904-0295",
    "FirstLinePracticeLocationAddress": "3626 NORTH HALL STREET (TWO OAK LAWN)",
    "SecondLinePracticeLocationAddress": "SUITE 610-N21",
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75219",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-904-0042",
    "PracticeLocationAddressFaxNumber": "469-904-0295",
    "EnumerationDate": "01/15/2026",
    "LastUpdateDate": "02/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BASEY",
    "AuthorizedOfficialFirstName": "RIVIERA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "804-761-0772",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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