Provider Demographics
NPI:1558909119
Name:MINDFUL JOURNEY, LLC
Entity Type:Organization
Organization Name:MINDFUL JOURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW, CAADC, AD
Authorized Official - Phone:269-350-4677
Mailing Address - Street 1:839 UPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-4848
Mailing Address - Country:US
Mailing Address - Phone:810-444-6298
Mailing Address - Fax:
Practice Address - Street 1:200 TURWILL LN STE 1
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4277
Practice Address - Country:US
Practice Address - Phone:269-350-4677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty