Provider Demographics
NPI:1770013195
Name:MINDFULBASICS, INC.
Entity Type:Organization
Organization Name:MINDFULBASICS, INC.
Other - Org Name:INTERGREEN SOLUTIONS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, LMTI, CE
Authorized Official - Phone:254-239-0255
Mailing Address - Street 1:PO BOX 2903
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-0903
Mailing Address - Country:US
Mailing Address - Phone:254-239-0255
Mailing Address - Fax:888-885-3928
Practice Address - Street 1:415 E FM 2410 RD UNIT 2903
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2938
Practice Address - Country:US
Practice Address - Phone:254-239-0255
Practice Address - Fax:888-885-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TXMT117863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT117863OtherLICENSED MASSAGE THERAPIST
TXCE1939OtherAPPROVED MASSAGE THERAPY CONTINUING EDUCATION (CE) PROVIDER
TXMI3364OtherLICENSED MASSAGE THERAPY INSTRUCTOR