Provider Demographics
NPI:1760183339
Name:MINDFUL GROWTH PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:MINDFUL GROWTH PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKINS ARCAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-315-0313
Mailing Address - Street 1:341 WESTRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8348
Mailing Address - Country:US
Mailing Address - Phone:773-315-0313
Mailing Address - Fax:
Practice Address - Street 1:715 HILL ST STE 130
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3572
Practice Address - Country:US
Practice Address - Phone:733-150-3137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty