Provider Demographics
NPI:1891221735
Name:MINDFUL GROWTH & TRAUMA RECOVERY, PLLC
Entity Type:Organization
Organization Name:MINDFUL GROWTH & TRAUMA RECOVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-944-2929
Mailing Address - Street 1:4425 S MO PAC EXPY STE 502
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6725
Mailing Address - Country:US
Mailing Address - Phone:512-270-1513
Mailing Address - Fax:
Practice Address - Street 1:4425 S MO PAC EXPY STE 502
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6725
Practice Address - Country:US
Practice Address - Phone:512-270-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty