Provider Demographics
NPI:1730745316
Name:CHALLENGING MINDS LLC
Entity type:Organization
Organization Name:CHALLENGING MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:860-385-2867
Mailing Address - Street 1:143 PINE HILL RD UNIT 17A
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1951
Mailing Address - Country:US
Mailing Address - Phone:860-921-8909
Mailing Address - Fax:
Practice Address - Street 1:30 PECK RD STE 1103B
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-385-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251S00000XAgenciesCommunity/Behavioral Health