Provider Demographics
NPI:1194547398
Name:MINDFUL SOLUTIONS ONLINE THERAPY LLC
Entity type:Organization
Organization Name:MINDFUL SOLUTIONS ONLINE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:248-935-1262
Mailing Address - Street 1:6179 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-9487
Mailing Address - Country:US
Mailing Address - Phone:248-935-1262
Mailing Address - Fax:
Practice Address - Street 1:6179 WILDERNESS DR
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-9487
Practice Address - Country:US
Practice Address - Phone:248-935-1262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)