Provider Demographics
NPI:1033876495
Name:MINDFULLY MAGNIFIED MENTAL HEALTH AND CONSULTING LLC
Entity Type:Organization
Organization Name:MINDFULLY MAGNIFIED MENTAL HEALTH AND CONSULTING LLC
Other - Org Name:MINDFULLY MAGNIFIED MENTAL HEALTH AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-300-9493
Mailing Address - Street 1:12940 HARRIET AVE S STE 260E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4138
Mailing Address - Country:US
Mailing Address - Phone:651-300-9493
Mailing Address - Fax:651-927-0210
Practice Address - Street 1:12940 HARRIET AVE S STE 260E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4138
Practice Address - Country:US
Practice Address - Phone:651-300-9493
Practice Address - Fax:651-927-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty