Provider Demographics
NPI:1144580531
Name:MINDFUL INTEGRATIVE THERAPY, LLC
Entity Type:Organization
Organization Name:MINDFUL INTEGRATIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIGNE
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-295-5840
Mailing Address - Street 1:1 OLD FLYING POINT RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6516
Mailing Address - Country:US
Mailing Address - Phone:207-295-5840
Mailing Address - Fax:207-865-6497
Practice Address - Street 1:1 OLD FLYING POINT RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6516
Practice Address - Country:US
Practice Address - Phone:207-295-5840
Practice Address - Fax:207-865-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT2503OtherSTATE LICENSE