Provider Demographics
NPI:1174348098
Name:UNTANGLED MINDS, LICENSED MARRIAGE AND FAMILY THERAPY, PROFESSIONAL CO
Entity type:Organization
Organization Name:UNTANGLED MINDS, LICENSED MARRIAGE AND FAMILY THERAPY, PROFESSIONAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS-HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-871-8666
Mailing Address - Street 1:5250 CLAREMONT AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5700
Mailing Address - Country:US
Mailing Address - Phone:209-871-8666
Mailing Address - Fax:
Practice Address - Street 1:5250 CLAREMONT AVE STE 113
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5700
Practice Address - Country:US
Practice Address - Phone:209-871-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty