Provider Demographics
NPI:1114782547
Name:MINDFUL PROVIDERS, PA
Entity Type:Organization
Organization Name:MINDFUL PROVIDERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-834-8040
Mailing Address - Street 1:6780 HORIZON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2104
Mailing Address - Country:US
Mailing Address - Phone:972-346-1885
Mailing Address - Fax:
Practice Address - Street 1:6780 HORIZON RD STE 102
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2104
Practice Address - Country:US
Practice Address - Phone:972-346-1885
Practice Address - Fax:903-454-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty