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General NPI Number Information
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NPI Number | 1346635349
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Entity Type | Organization
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Legal Business Name | MINDS IN MOTION INTEGRATED BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 4142 OGLETOWN STANTON RD MAILBOX 210
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City | NEWARK
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State | DE
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Zip | 19713-4169
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Country | US
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Telephone | 302-743-5486
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Fax |
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Provider Business Mailing Address
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Address Line | 4142 OGLETOWN STANTON RD MAILBOX 210
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City | NEWARK
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State | DE
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Zip | 19713-4169
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Country | US
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Telephone | 302-743-5486
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECIUTIVE OFFICER
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Name | TERI B LAWLER
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Credential | MA
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Telephone | 302-743-5486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2015602352
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License Number State | DE
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