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
StateLicense IDTaxonomies
CO221251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health