Provider Demographics
NPI:1235845058
Name:MINDFUL THERAPY LLC
Entity Type:Organization
Organization Name:MINDFUL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGET
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:512-512-8347
Mailing Address - Street 1:15813 W DORMAN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5470
Mailing Address - Country:US
Mailing Address - Phone:512-810-8347
Mailing Address - Fax:
Practice Address - Street 1:7701 N LAMAR BLVD STE 331
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1080
Practice Address - Country:US
Practice Address - Phone:512-337-6752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)