MEDICARE: THE MIND DOCTOR TRAINING & CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1821841891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MIND DOCTOR TRAINING & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	1040 BEDFORD GARDENS DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-6276
Country	:	US
Telephone Number	:	770-823-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 BEDFORD GARDENS DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-6276
Country	:	US
Telephone Number	:	770-823-2277
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	RUSSELL KAWAKAMI
Credential	:	PH.D
Telephone Number	:	770-823-2277

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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