Provider Demographics
NPI:1609316256
Name:DEVELOP MINDED THERAPIES
Entity type:Organization
Organization Name:DEVELOP MINDED THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-750-2664
Mailing Address - Street 1:4040 S TYLER ST
Mailing Address - Street 2:9
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2158
Mailing Address - Country:US
Mailing Address - Phone:253-750-2664
Mailing Address - Fax:253-276-1917
Practice Address - Street 1:4040 S TYLER ST
Practice Address - Street 2:9
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2158
Practice Address - Country:US
Practice Address - Phone:253-750-2664
Practice Address - Fax:253-276-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty