Provider Demographics
NPI:1194505974
Name:THE MINDFUL 60 LLC
Entity type:Organization
Organization Name:THE MINDFUL 60 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-210-9147
Mailing Address - Street 1:131 PLANTATION TRCE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-8807
Mailing Address - Country:US
Mailing Address - Phone:318-210-9147
Mailing Address - Fax:
Practice Address - Street 1:401 HAMILTON RD STE 114
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4615
Practice Address - Country:US
Practice Address - Phone:318-210-9147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)