Provider Demographics
NPI:1619741568
Name:MINDFUL HEALING NW
Entity Type:Organization
Organization Name:MINDFUL HEALING NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-208-6643
Mailing Address - Street 1:2086 NE LUCY BELLE ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9261
Mailing Address - Country:US
Mailing Address - Phone:503-208-6643
Mailing Address - Fax:
Practice Address - Street 1:2086 NE LUCY BELLE ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9261
Practice Address - Country:US
Practice Address - Phone:503-208-6643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty