Provider Demographics
NPI: | 1902246002 |
---|---|
Name: | MIND AND MUSCLE, LLC |
Entity Type: | Organization |
Organization Name: | MIND AND MUSCLE, LLC |
Other - Org Name: | PAUL SLAUGHTER, LMFT |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PSYCHOTHERAPIST |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | WILSON |
Authorized Official - Last Name: | SLAUGHTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 970-988-7042 |
Mailing Address - Street 1: | 315 CANYON AVE |
Mailing Address - Street 2: | SUITE B. |
Mailing Address - City: | FORT COLLINS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80521-2677 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-988-7042 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 315 CANYON AVE |
Practice Address - Street 2: | SUITE B. |
Practice Address - City: | FORT COLLINS |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80521-2677 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-988-7042 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-07-03 |
Last Update Date: | 2013-07-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 221 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |