Provider Demographics
NPI:1376200600
Name:THE CENTER FOR MINDFUL HEALING
Entity Type:Organization
Organization Name:THE CENTER FOR MINDFUL HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CERTIFIED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:501-626-8606
Mailing Address - Street 1:10614 YOSEMITE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3657
Mailing Address - Country:US
Mailing Address - Phone:501-626-8606
Mailing Address - Fax:501-424-5399
Practice Address - Street 1:7509 CANTRELL RD STE 217
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-2500
Practice Address - Country:US
Practice Address - Phone:501-626-8606
Practice Address - Fax:501-424-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)