Provider Demographics
NPI:1114567039
Name:MINDFUL CHANGE, PLLC
Entity Type:Organization
Organization Name:MINDFUL CHANGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:832-725-5987
Mailing Address - Street 1:3731 RIO VISTA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1513
Mailing Address - Country:US
Mailing Address - Phone:832-725-5987
Mailing Address - Fax:
Practice Address - Street 1:3220 SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2910
Practice Address - Country:US
Practice Address - Phone:281-777-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health