Provider Demographics
NPI:1679155667
Name:MIND RAISING THERAPY LLC
Entity type:Organization
Organization Name:MIND RAISING THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTE GRACIO
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:531-239-4701
Mailing Address - Street 1:10840 OLD MILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2664
Mailing Address - Country:US
Mailing Address - Phone:531-239-4701
Mailing Address - Fax:
Practice Address - Street 1:10840 OLD MILL RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2664
Practice Address - Country:US
Practice Address - Phone:531-239-4701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)