Provider Demographics
NPI:1386223568
Name:MINDFULNESS & HEALTHY LIVING
Entity Type:Organization
Organization Name:MINDFULNESS & HEALTHY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-293-8481
Mailing Address - Street 1:10260 SW GREENBURG RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5514
Mailing Address - Country:US
Mailing Address - Phone:503-293-8481
Mailing Address - Fax:
Practice Address - Street 1:10260 SW GREENBURG RD STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5514
Practice Address - Country:US
Practice Address - Phone:503-293-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service