Provider Demographics
NPI:1659994408
Name:MINDFUL DBT, LLC
Entity Type:Organization
Organization Name:MINDFUL DBT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MH, QMHP
Authorized Official - Phone:605-321-9906
Mailing Address - Street 1:5708 S REMINGTON PL STE 400
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5160
Mailing Address - Country:US
Mailing Address - Phone:650-321-9906
Mailing Address - Fax:
Practice Address - Street 1:5708 S REMINGTON PL STE 400
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5160
Practice Address - Country:US
Practice Address - Phone:650-321-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)