Provider Demographics
NPI:1366717845
Name:MINDFUL NEUROPSYCHOLOGY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MINDFUL NEUROPSYCHOLOGY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-589-6155
Mailing Address - Street 1:9255 TOWNE CENTRE DR STE 875
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3064
Mailing Address - Country:US
Mailing Address - Phone:858-888-2668
Mailing Address - Fax:858-455-5556
Practice Address - Street 1:9255 TOWNE CENTRE DR STE 875
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3064
Practice Address - Country:US
Practice Address - Phone:858-888-2668
Practice Address - Fax:858-455-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20782103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty