Provider Demographics
NPI:1003442393
Name:MINDFUL LIFE THERAPY
Entity Type:Organization
Organization Name:MINDFUL LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN-NAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-750-7448
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-0446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18411 CRENSHAW BLVD STE 432
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5042
Practice Address - Country:US
Practice Address - Phone:310-750-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)