Provider Demographics
NPI:1851889430
Name:MINDFUL PSYCHOTHERAPY SERVICES PC
Entity Type:Organization
Organization Name:MINDFUL PSYCHOTHERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:248-737-2753
Mailing Address - Street 1:31700 W 13 MILE RD STE 219
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2171
Mailing Address - Country:US
Mailing Address - Phone:248-613-0594
Mailing Address - Fax:248-855-5959
Practice Address - Street 1:31700 W 13 MILE RD STE 219
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2171
Practice Address - Country:US
Practice Address - Phone:248-613-0594
Practice Address - Fax:248-855-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty