Provider Demographics
NPI:1073841276
Name:MINDFUL PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:MINDFUL PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAJODIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-353-3345
Mailing Address - Street 1:13355 WINSTANLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1403
Mailing Address - Country:US
Mailing Address - Phone:858-353-3345
Mailing Address - Fax:858-452-3992
Practice Address - Street 1:5230 CARROLL CANYON RD STE 316
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1781
Practice Address - Country:US
Practice Address - Phone:858-353-3345
Practice Address - Fax:858-800-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23133103TA0400X, 103TA0700X, 103TC0700X
PSY 23133103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHF485AMedicare PIN