Provider Demographics
NPI:1922626381
Name:MINDFUL WELLNESS AND RECOVERY
Entity Type:Organization
Organization Name:MINDFUL WELLNESS AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-341-3614
Mailing Address - Street 1:3938 COUNTY ROAD 356
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-7131
Mailing Address - Country:US
Mailing Address - Phone:979-341-3614
Mailing Address - Fax:
Practice Address - Street 1:3938 COUNTY ROAD 356
Practice Address - Street 2:
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422-7131
Practice Address - Country:US
Practice Address - Phone:979-341-3614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty