Provider Demographics
NPI:1336722016
Name:MINDFUL HEALING TRANSFORMATIONS
Entity Type:Organization
Organization Name:MINDFUL HEALING TRANSFORMATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:GRANGER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-993-4668
Mailing Address - Street 1:1210 DRY HOLLOW RD STE 6
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3167
Mailing Address - Country:US
Mailing Address - Phone:541-993-4668
Mailing Address - Fax:
Practice Address - Street 1:1210 DRY HOLLOW RD STE 6
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3167
Practice Address - Country:US
Practice Address - Phone:541-993-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty