Provider Demographics
NPI:1457713489
Name:MINDFUL LIVING LLC
Entity Type:Organization
Organization Name:MINDFUL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-417-5851
Mailing Address - Street 1:221 MAITLAND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3939
Mailing Address - Country:US
Mailing Address - Phone:443-417-5851
Mailing Address - Fax:
Practice Address - Street 1:221 MAITLAND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3939
Practice Address - Country:US
Practice Address - Phone:443-417-5851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty