Provider Demographics
NPI:1104509710
Name:MINDFUL CONNECTIONS COUNSELING AND LEARNING CENTER, PLLC
Entity type:Organization
Organization Name:MINDFUL CONNECTIONS COUNSELING AND LEARNING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-818-1561
Mailing Address - Street 1:3509 E SHEA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3338
Mailing Address - Country:US
Mailing Address - Phone:480-808-9535
Mailing Address - Fax:
Practice Address - Street 1:3509 E SHEA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3338
Practice Address - Country:US
Practice Address - Phone:480-808-9535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty