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General NPI Number Information
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NPI Number | 1245797091
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Entity Type | Organization
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Legal Business Name | MINDTUNE LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 4305 GESNER ST STE 215
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City | SAN DIEGO
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State | CA
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Zip | 92117-6677
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Country | US
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Telephone | 619-586-9897
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Fax |
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Provider Business Mailing Address
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Address Line | 111 BANCROFT ST # 4421
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3674
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Country | US
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Telephone | 760-712-9817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE WOLFE
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Credential | PHD
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Telephone | 210-837-8625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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