Provider Demographics
NPI:1023617578
Name:MINDFUL SOUL COUNSELING, LLC
Entity type:Organization
Organization Name:MINDFUL SOUL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-286-5400
Mailing Address - Street 1:2 MAIN ST STE 18-223
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2069
Mailing Address - Country:US
Mailing Address - Phone:207-286-5400
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST STE 18-223
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2069
Practice Address - Country:US
Practice Address - Phone:207-286-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty