Provider Demographics
NPI:1174161640
Name:MINDSCAPES
Entity type:Organization
Organization Name:MINDSCAPES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-604-6067
Mailing Address - Street 1:1241 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7989
Mailing Address - Country:US
Mailing Address - Phone:614-604-6067
Mailing Address - Fax:614-604-6529
Practice Address - Street 1:1241 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7989
Practice Address - Country:US
Practice Address - Phone:614-604-6067
Practice Address - Fax:614-604-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0380208Medicaid
OH1023631447OtherOTPTAT BOARD
OH1659703676OtherPSYCHOLOGY BOARD
OH1063972362OtherSPEECH AND HEARING PROFESSIONALS BOARD
OH1720497217OtherSPEECH AND HEARING PROFESSIONALS BOARD
OH1851925465OtherCOTA/L