Provider Demographics
NPI:1538889936
Name:MIND DYNAMICS LLC
Entity type:Organization
Organization Name:MIND DYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTTERHOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-415-1148
Mailing Address - Street 1:17 FARMINGTON AVE STE B4
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1774
Mailing Address - Country:US
Mailing Address - Phone:310-415-1148
Mailing Address - Fax:
Practice Address - Street 1:17 FARMINGTON AVE STE B4
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1774
Practice Address - Country:US
Practice Address - Phone:310-415-1148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty