Provider Demographics
NPI:1013583632
Name:MINDFUL SYNERGY
Entity Type:Organization
Organization Name:MINDFUL SYNERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW
Authorized Official - Phone:313-608-9512
Mailing Address - Street 1:3011 W GRAND BLVD STE 1507
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3000
Mailing Address - Country:US
Mailing Address - Phone:313-608-9512
Mailing Address - Fax:313-462-4829
Practice Address - Street 1:3011 W GRAND BLVD STE 1507
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3000
Practice Address - Country:US
Practice Address - Phone:313-608-9512
Practice Address - Fax:313-462-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health