Provider Demographics
NPI:1821730359
Name:MINDFUL POSSIBILITIES LLC
Entity Type:Organization
Organization Name:MINDFUL POSSIBILITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:BOES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:817-382-1876
Mailing Address - Street 1:610 S JENNINGS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3209
Mailing Address - Country:US
Mailing Address - Phone:817-382-1876
Mailing Address - Fax:
Practice Address - Street 1:610 S JENNINGS AVE STE C
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3209
Practice Address - Country:US
Practice Address - Phone:817-382-1876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty