Provider Demographics
NPI:1104410281
Name:MINDFUL HOLISTICS, LLC
Entity type:Organization
Organization Name:MINDFUL HOLISTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULBACKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:603-318-2635
Mailing Address - Street 1:75 RAILROAD AVE UNIT B4
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-3540
Mailing Address - Country:US
Mailing Address - Phone:603-318-2635
Mailing Address - Fax:
Practice Address - Street 1:75 RAILROAD AVE UNIT B4
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-3540
Practice Address - Country:US
Practice Address - Phone:603-318-2635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty