1003798901 NPI number — MIND REWIRED PSYCHOTHERAPY LLC

Table of content: (NPI 1003798901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003798901 NPI number — MIND REWIRED PSYCHOTHERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIND REWIRED PSYCHOTHERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003798901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 193
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70404-0193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-361-9570
Provider Business Mailing Address Fax Number:
985-202-8433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 NW RAILROAD AVE UNIT 193
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70404-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-361-9570
Provider Business Practice Location Address Fax Number:
985-202-8433
Provider Enumeration Date:
07/22/2025

Additional Information

Authorized Official

Authorized Official Last Name:
LABONTE
Authorized Official First Name:
VASILIKI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/COUNSELOR
Authorized Official Telephone Number:
985-361-9570

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com