=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780362137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CULTURE IN MIND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2023
-----------------------------------------------------
Last Update Date | 07/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4315 GUADALUPE ST STE 206B
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78751-3644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-648-3641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5900 CAMERON RD APT 1018
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78723-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-781-4888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | SAMANTHA BENN
-----------------------------------------------------
Credential | LCSW-S
-----------------------------------------------------
Telephone | 512-781-4888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------