Provider Demographics
NPI:1699222794
Name:MINDFUL CHANGE COUNSELING, LLC
Entity type:Organization
Organization Name:MINDFUL CHANGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:LAMBERT
Authorized Official - Last Name:THORNDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-510-4807
Mailing Address - Street 1:1342 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4907
Mailing Address - Country:US
Mailing Address - Phone:360-510-4807
Mailing Address - Fax:
Practice Address - Street 1:119 N COMMERCIAL ST
Practice Address - Street 2:#375
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-510-4807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 603890921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty