Provider Demographics
NPI:1578229738
Name:MINDFUL PURPOSE-GUIDED COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MINDFUL PURPOSE-GUIDED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-229-8970
Mailing Address - Street 1:PO BOX 33197
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-3197
Mailing Address - Country:US
Mailing Address - Phone:817-229-8970
Mailing Address - Fax:
Practice Address - Street 1:7101 BRYANT IRVIN RD # 33197
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4135
Practice Address - Country:US
Practice Address - Phone:817-229-8970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health