Provider Demographics
NPI:1194422907
Name:MINDFUL INNOVATIONS LLC
Entity type:Organization
Organization Name:MINDFUL INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MCCOULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-920-6450
Mailing Address - Street 1:106 VISTA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-9510
Mailing Address - Country:US
Mailing Address - Phone:804-723-6463
Mailing Address - Fax:
Practice Address - Street 1:106 VISTA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-9510
Practice Address - Country:US
Practice Address - Phone:804-723-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)