Organization
AUTHENTIC & INTENTIONAL MINDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY D COULTER LCSW (OWNER)
(682) 302-1338
Entity
Organization
Contact information
Practice address
10011 STONELAKE BLVD APT 366, AUSTIN, TX 78759-6097
(682) 302-1359
Mailing address
10011 STONELAKE BLVD APT 366, AUSTIN, TX 78759-6097
(682) 302-1338
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/04/2021
Last updated
09/14/2021
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