Provider Demographics
NPI:1679124408
Name:MIND MANAGEMENT INSTITUTE INC
Entity type:Organization
Organization Name:MIND MANAGEMENT INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THIERA
Authorized Official - Middle Name:DANYAL
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LP, LPC
Authorized Official - Phone:313-800-2497
Mailing Address - Street 1:1771 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6645
Mailing Address - Country:US
Mailing Address - Phone:313-800-2497
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR STE 239
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5206
Practice Address - Country:US
Practice Address - Phone:313-800-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)