Provider Demographics
NPI:1275311912
Name:MINDFUL MENDING LLC
Entity Type:Organization
Organization Name:MINDFUL MENDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:304-617-7331
Mailing Address - Street 1:5322 HAVENTREE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2263
Mailing Address - Country:US
Mailing Address - Phone:304-617-7331
Mailing Address - Fax:
Practice Address - Street 1:1169 EASTERN PKWY STE 1236
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1462
Practice Address - Country:US
Practice Address - Phone:304-617-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty