Provider Demographics
NPI:1144982695
Name:THRIVING MINDS THERAPY SERVICES-JC CORP
Entity type:Organization
Organization Name:THRIVING MINDS THERAPY SERVICES-JC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIHEEM
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-415-4950
Mailing Address - Street 1:906 VIRGINIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6763
Mailing Address - Country:US
Mailing Address - Phone:575-214-9215
Mailing Address - Fax:575-377-8254
Practice Address - Street 1:906 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6763
Practice Address - Country:US
Practice Address - Phone:575-214-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)