Provider Demographics
NPI:1932307683
Name:MINDFUL, INC
Entity Type:Organization
Organization Name:MINDFUL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CANTER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-567-4595
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-0923
Mailing Address - Country:US
Mailing Address - Phone:360-567-4595
Mailing Address - Fax:360-213-1816
Practice Address - Street 1:2403 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3228
Practice Address - Country:US
Practice Address - Phone:360-567-4595
Practice Address - Fax:360-213-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000090731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty