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General NPI Number Information
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NPI Number | 1396221735
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Entity Type | Organization
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Legal Business Name | THE TRAUMA MASTERMINDS
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 660 HILL RD N
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City | PICKERINGTON
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State | OH
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Zip | 43147-9201
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Country | US
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Telephone | 614-604-3475
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Fax | 206-338-2103
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Provider Business Mailing Address
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Address Line | 660 HILL RD N
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City | PICKERINGTON
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State | OH
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Zip | 43147-9201
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Country | US
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Telephone | 614-604-3475
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Fax | 206-338-2103
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. CHRISTINA M MINOGUCHI
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Credential | LISW-S
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Telephone | 614-604-3475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-0028045
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License Number State | OH
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