Provider Demographics
NPI:1861167371
Name:THE MINDFULNESS GROUP, LLC
Entity type:Organization
Organization Name:THE MINDFULNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:440-935-6288
Mailing Address - Street 1:16000 W SPRAGUE RD # 190
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-935-6288
Mailing Address - Fax:
Practice Address - Street 1:16000 W SPRAGUE RD # 190
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-935-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)