Provider Demographics
NPI:1174265383
Name:MINDFUL CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MINDFUL CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, MINDFUL CLINICAL SERVIC
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:WAKACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:747-228-2621
Mailing Address - Street 1:1923 1/2 WESTWOOD BLVD, SUITE 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:747-228-2621
Mailing Address - Fax:
Practice Address - Street 1:1923 1/2 WESTWOOD BLVD, SUITE 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:747-228-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty