Provider Demographics
NPI:1407249303
Name:MINDFUL MATTERS LLC
Entity Type:Organization
Organization Name:MINDFUL MATTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANDEN HEUVEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCP
Authorized Official - Phone:920-209-0604
Mailing Address - Street 1:W2274 OUT OF TOWN LN
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-9474
Mailing Address - Country:US
Mailing Address - Phone:920-209-0604
Mailing Address - Fax:
Practice Address - Street 1:W2274 OUT OF TOWN LN
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-9474
Practice Address - Country:US
Practice Address - Phone:920-209-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4647-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174831473Medicaid