Provider Demographics
NPI:1265067011
Name:MINDFUL HEART FAMILY THERAPY, INC
Entity type:Organization
Organization Name:MINDFUL HEART FAMILY THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-835-1222
Mailing Address - Street 1:PO BOX 4201
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-4201
Mailing Address - Country:US
Mailing Address - Phone:805-835-1222
Mailing Address - Fax:
Practice Address - Street 1:1411 MARSH ST STE 108
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2967
Practice Address - Country:US
Practice Address - Phone:805-602-6845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty