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General NPI Number Information
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NPI Number | 1821698721
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Entity Type | Organization
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Legal Business Name | MIND AND THERAPY CLINIC
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 130 N PRESTON RD STE 356
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City | PROSPER
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State | TX
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Zip | 75078-9808
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Country | US
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Telephone | 972-254-4444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 341
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City | PROSPER
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State | TX
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Zip | 75078-0341
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Country | US
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Telephone | 941-932-3886
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | RODREGO WAY
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Credential | LPC, LCDC
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Telephone | 941-932-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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