Provider Demographics
NPI:1669157392
Name:MYNDFUL MOMENTS
Entity type:Organization
Organization Name:MYNDFUL MOMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-600-2121
Mailing Address - Street 1:3631 SHALE CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1247
Mailing Address - Country:US
Mailing Address - Phone:775-600-2121
Mailing Address - Fax:
Practice Address - Street 1:85 KEYSTONE AVE STE 205G
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5571
Practice Address - Country:US
Practice Address - Phone:775-600-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740535749OtherPERSONAL TYPE 1 NPI