Provider Demographics
NPI:1609149459
Name:WHOLE MIND WELLNESS SERVICES
Entity Type:Organization
Organization Name:WHOLE MIND WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MACON-RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-283-5888
Mailing Address - Street 1:32 S RAYMOND AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1961
Mailing Address - Country:US
Mailing Address - Phone:626-283-5888
Mailing Address - Fax:
Practice Address - Street 1:32 S RAYMOND AVE STE 3B
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1961
Practice Address - Country:US
Practice Address - Phone:626-283-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26253251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health