Provider Demographics
NPI:1235757600
Name:MINDFULLY HEALING INC.
Entity Type:Organization
Organization Name:MINDFULLY HEALING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-562-9880
Mailing Address - Street 1:4154 SHORELINE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-5606
Mailing Address - Country:US
Mailing Address - Phone:952-491-9450
Mailing Address - Fax:952-491-9460
Practice Address - Street 1:4154 SHORELINE DR STE 202
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-5606
Practice Address - Country:US
Practice Address - Phone:952-491-9450
Practice Address - Fax:952-491-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty