Provider Demographics
NPI:1639888431
Name:MINDFUL GROWTH UNLIMITED
Entity Type:Organization
Organization Name:MINDFUL GROWTH UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:URRUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-515-8844
Mailing Address - Street 1:1075 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3529
Mailing Address - Country:US
Mailing Address - Phone:860-515-8844
Mailing Address - Fax:
Practice Address - Street 1:1176 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2302
Practice Address - Country:US
Practice Address - Phone:860-515-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty