Provider Demographics
NPI:1790534204
Name:KIND MINDS EARLY INTERVENTION SERVICES, LLC
Entity type:Organization
Organization Name:KIND MINDS EARLY INTERVENTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BCBA
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERREN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:404-242-9210
Mailing Address - Street 1:3257 BLUE JASMINE LN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3339
Mailing Address - Country:US
Mailing Address - Phone:404-242-9210
Mailing Address - Fax:
Practice Address - Street 1:3257 BLUE JASMINE LN
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3339
Practice Address - Country:US
Practice Address - Phone:404-242-9210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency