Provider Demographics
NPI:1013647650
Name:A MINDFUL CONNECTION TELEMENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:A MINDFUL CONNECTION TELEMENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TELEHEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:BITTNER
Authorized Official - Last Name:ZERFOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-770-3318
Mailing Address - Street 1:265 BURGESS RD # 1013
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3718
Mailing Address - Country:US
Mailing Address - Phone:239-770-3318
Mailing Address - Fax:
Practice Address - Street 1:3221 DANBURY CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-9324
Practice Address - Country:US
Practice Address - Phone:239-770-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health