Provider Demographics
NPI:1194229203
Name:MINDFUL PURPOSE COUNSELING PLLC
Entity Type:Organization
Organization Name:MINDFUL PURPOSE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:828-595-4116
Mailing Address - Street 1:681 DOTSI DR
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-7459
Mailing Address - Country:US
Mailing Address - Phone:828-595-4116
Mailing Address - Fax:
Practice Address - Street 1:196 WHITMIRE ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4498
Practice Address - Country:US
Practice Address - Phone:828-595-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5234251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health