Provider Demographics
NPI:1619268729
Name:MINDFUL HEALTH ADVANTAGE, LLC
Entity Type:Organization
Organization Name:MINDFUL HEALTH ADVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-202-6143
Mailing Address - Street 1:777 S WADSWORTH BLVD
Mailing Address - Street 2:BLDG 2, STE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4300
Mailing Address - Country:US
Mailing Address - Phone:303-202-6143
Mailing Address - Fax:303-202-6146
Practice Address - Street 1:777 S WADSWORTH BLVD
Practice Address - Street 2:BLDG 2, STE 103
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4300
Practice Address - Country:US
Practice Address - Phone:303-202-6143
Practice Address - Fax:303-202-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty