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General NPI Number Information
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NPI Number | 1619403631
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Entity Type | Organization
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Legal Business Name | MINDWISE CORPORATION
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 386 W MAIN STREET SUITE 105
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City | NEW CASTLE
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State | CO
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Zip | 81647
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Country | US
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Telephone | 970-319-1999
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Fax | 970-319-1999
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Provider Business Mailing Address
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Address Line | PO BOX 556
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City | NEW CASTLE
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State | CO
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Zip | 81647-0556
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Country | US
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Telephone | 970-319-1999
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Fax | 970-550-7555
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Authorized Official
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Title or Position | PRESIDENT, THERAPIST
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Name | MARY ELIZABETH BOWLES
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Credential | LMFT, RRT, MIACN
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Telephone | 970-319-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT.0001316
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License Number State | CO
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