Provider Demographics
NPI:1285354423
Name:HUMANISTIC MINDFULNESS CENTER LLC
Entity type:Organization
Organization Name:HUMANISTIC MINDFULNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SISUNG
Authorized Official - Suffix:III
Authorized Official - Credentials:LLP
Authorized Official - Phone:734-972-8555
Mailing Address - Street 1:1320 KINGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2144
Mailing Address - Country:US
Mailing Address - Phone:734-972-8555
Mailing Address - Fax:
Practice Address - Street 1:595 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1775
Practice Address - Country:US
Practice Address - Phone:734-972-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty