Provider Demographics
NPI:1134930738
Name:MINDFUL COUNSELING AND SUPERVISION PLLC
Entity type:Organization
Organization Name:MINDFUL COUNSELING AND SUPERVISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-377-4226
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-1528
Mailing Address - Country:US
Mailing Address - Phone:623-377-4226
Mailing Address - Fax:
Practice Address - Street 1:2111 E BASELINE RD STE D3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1520
Practice Address - Country:US
Practice Address - Phone:623-377-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)