Provider Demographics
NPI:1609514918
Name:MINDFULLY BLESSED LLC
Entity Type:Organization
Organization Name:MINDFULLY BLESSED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:218-591-6023
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:BIWABIK
Mailing Address - State:MN
Mailing Address - Zip Code:55708-0498
Mailing Address - Country:US
Mailing Address - Phone:218-591-6023
Mailing Address - Fax:
Practice Address - Street 1:202 MESABI LOCATION N
Practice Address - Street 2:
Practice Address - City:BIWABIK
Practice Address - State:MN
Practice Address - Zip Code:55708
Practice Address - Country:US
Practice Address - Phone:218-212-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health