Provider Demographics
NPI:1861837122
Name:MINDFUL THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:MINDFUL THERAPY CENTER, LLC
Other - Org Name:MINDFUL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-353-5608
Mailing Address - Street 1:105 EVESBORO MEDFORD RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3865
Mailing Address - Country:US
Mailing Address - Phone:609-353-5608
Mailing Address - Fax:609-798-0092
Practice Address - Street 1:105 EVESBORO MEDFORD RD
Practice Address - Street 2:SUITE M
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3865
Practice Address - Country:US
Practice Address - Phone:609-353-5608
Practice Address - Fax:609-798-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty