Provider Demographics
NPI:1699241059
Name:MINDFUL CHANGES, PLLC
Entity type:Organization
Organization Name:MINDFUL CHANGES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LE'SHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-646-0156
Mailing Address - Street 1:41217 CANTON CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1472
Mailing Address - Country:US
Mailing Address - Phone:313-646-0156
Mailing Address - Fax:
Practice Address - Street 1:36500 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3169
Practice Address - Country:US
Practice Address - Phone:313-646-0156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty