Provider Demographics
NPI:1811563497
Name:MINDFUL PRIMARY & PSYCH CARE
Entity Type:Organization
Organization Name:MINDFUL PRIMARY & PSYCH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:SERESEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-781-6772
Mailing Address - Street 1:2300 CLEAR CREEK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5404
Mailing Address - Country:US
Mailing Address - Phone:254-781-6772
Mailing Address - Fax:
Practice Address - Street 1:2300 CLEAR CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5404
Practice Address - Country:US
Practice Address - Phone:254-781-6772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty