Provider Demographics
NPI:1356856843
Name:MINDFULLNESS LLC
Entity type:Organization
Organization Name:MINDFULLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:248-686-0346
Mailing Address - Street 1:1750 S TELEGRAPH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0177
Mailing Address - Country:US
Mailing Address - Phone:248-686-0346
Mailing Address - Fax:248-686-0346
Practice Address - Street 1:1750 S TELEGRAPH RD STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0177
Practice Address - Country:US
Practice Address - Phone:248-686-0346
Practice Address - Fax:248-686-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty