Provider Demographics
NPI:1558136226
Name:MINDFUL EVOLUTION, L.L.C.
Entity Type:Organization
Organization Name:MINDFUL EVOLUTION, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-875-3830
Mailing Address - Street 1:200 FORT MEADE RD APT 1107
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4420
Mailing Address - Country:US
Mailing Address - Phone:301-875-3830
Mailing Address - Fax:
Practice Address - Street 1:200 FORT MEADE RD APT 1107
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4420
Practice Address - Country:US
Practice Address - Phone:301-875-3830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty