Provider Demographics
NPI:1962001651
Name:MINDFUL MATTERS LLC
Entity Type:Organization
Organization Name:MINDFUL MATTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-838-8484
Mailing Address - Street 1:12 JARVIS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-4313
Mailing Address - Country:US
Mailing Address - Phone:508-838-8484
Mailing Address - Fax:
Practice Address - Street 1:12 JARVIS LN
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4313
Practice Address - Country:US
Practice Address - Phone:508-838-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11900OtherBOARD OF ALLIED MENTAL HEALTH