Provider Demographics
NPI:1821777939
Name:MINDFULLY RE-ALIGN LLC
Entity Type:Organization
Organization Name:MINDFULLY RE-ALIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT, LBSW
Authorized Official - Phone:316-364-1495
Mailing Address - Street 1:250 N ROCK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2261
Mailing Address - Country:US
Mailing Address - Phone:316-364-1495
Mailing Address - Fax:
Practice Address - Street 1:250 N ROCK RD STE 130
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2261
Practice Address - Country:US
Practice Address - Phone:316-364-1495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty