NPIMap

Organization Active NPI

Mind Sight LLC

Doing business as Mind Your Self

  • Clinical Social Worker
  • San Antonio, TX
National Provider Identifier
1649653908
Registry record updated Jul 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
60147 Issued in TX
Legal business name
MIND SIGHT LLC
Doing business as
Mind Your Self
Practice address
1314 Fontaine Dr
San Antonio, TX 78219-2515
Phone
(210) 819-1435
Fax
(210) 503-5867
NPI assigned
Jul 6, 2015
Last updated
Jul 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carla Lee Groves, LCSWNPI 1255729943
Title
Owner
Phone
(210) 819-1435

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 60147 TX Primary

Addresses

Primary practice location

1314 Fontaine Dr
San Antonio, TX 78219-2515

Mailing address

1314 Fontaine Dr
San Antonio, TX 78219-2515
Phone (210) 819-1435

Other identifiers 1

IdentifierTypeStateIssuer
60147OtherTXLICENSE

Other names 1

  • Mind Your Self Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150813012253 TX Part B Supplier - Clinic/Group Practice 0648585067 Receives reassigned benefits from 13 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

17503 La Cantera Pkwy
#102293
San Antonio, TX 78257
Phone (210) 564-9116

17503 La Cantera Pkwy
#104293
San Antonio, TX 78257
Phone (210) 564-9116

4203 Woodcock Dr
Ste 216
San Antonio, TX 78228
Phone (210) 564-9116

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436140800000",
    "number": "1649653908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 FONTAINE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782192515",
            "telephone_number": "210-819-1435",
            "fax_number": "210-503-5867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 FONTAINE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782192515",
            "telephone_number": "210-819-1435",
            "fax_number": "210-503-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND SIGHT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-06",
        "last_updated": "2015-07-06",
        "status": "A",
        "authorized_official_last_name": "GROVES",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-819-1435",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "60147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "60147",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Your Self",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.