Provider Demographics
NPI:1992355689
Name:MINDFUL PSYCHOLOGICAL HEALTH, PLLC
Entity type:Organization
Organization Name:MINDFUL PSYCHOLOGICAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-260-8034
Mailing Address - Street 1:11350 RANDOM HILLS RD STE 800
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6044
Mailing Address - Country:US
Mailing Address - Phone:571-260-8034
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 800
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6044
Practice Address - Country:US
Practice Address - Phone:571-260-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty