Provider Demographics
NPI:1114644960
Name:MINDFUL CONNECTIONS, LLC
Entity Type:Organization
Organization Name:MINDFUL CONNECTIONS, LLC
Other - Org Name:MINDFUL CONNECTION THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-628-6397
Mailing Address - Street 1:618 S 1550 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8117
Mailing Address - Country:US
Mailing Address - Phone:801-628-6397
Mailing Address - Fax:
Practice Address - Street 1:780 S 2000 W STE A105
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9612
Practice Address - Country:US
Practice Address - Phone:801-628-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty