Provider Demographics
NPI:1447863683
Name:MINDSCAPE WELLNESS LLC
Entity type:Organization
Organization Name:MINDSCAPE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BERESFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-509-5771
Mailing Address - Street 1:4545 N 36TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3473
Mailing Address - Country:US
Mailing Address - Phone:602-509-5771
Mailing Address - Fax:
Practice Address - Street 1:4545 N 36TH ST STE 117
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3473
Practice Address - Country:US
Practice Address - Phone:602-509-5771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty