Provider Demographics
NPI:1063713493
Name:MINDFUL THERAPEUTICS, LLC
Entity type:Organization
Organization Name:MINDFUL THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAIGHT-TARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-784-1080
Mailing Address - Street 1:10621 AIRPORT PULLING RD N
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7333
Mailing Address - Country:US
Mailing Address - Phone:239-784-1080
Mailing Address - Fax:
Practice Address - Street 1:10621 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 7
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7333
Practice Address - Country:US
Practice Address - Phone:239-784-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty