Provider Demographics
NPI:1790201184
Name:MINDFUL WELLNESS MAUI LLC
Entity Type:Organization
Organization Name:MINDFUL WELLNESS MAUI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-740-8425
Mailing Address - Street 1:95 E LIPOA ST STE 209
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8191
Mailing Address - Country:US
Mailing Address - Phone:808-740-8425
Mailing Address - Fax:
Practice Address - Street 1:95 E LIPOA ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8194
Practice Address - Country:US
Practice Address - Phone:808-463-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty