Provider Demographics
NPI:1366199820
Name:MINDGARDEN THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:MINDGARDEN THERAPEUTIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POTTHAST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC, DSW
Authorized Official - Phone:210-508-4688
Mailing Address - Street 1:667 ARROYO SIERRA
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0190
Mailing Address - Country:US
Mailing Address - Phone:830-660-1006
Mailing Address - Fax:
Practice Address - Street 1:667 ARROYO SIERRA
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0190
Practice Address - Country:US
Practice Address - Phone:830-660-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty