Provider Demographics
NPI:1700358603
Name:MINDFUL PATH COUNSELING & WELLNESS PLLC
Entity Type:Organization
Organization Name:MINDFUL PATH COUNSELING & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-932-1463
Mailing Address - Street 1:621 N MAIN ST STE 435
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9218
Mailing Address - Country:US
Mailing Address - Phone:469-556-5234
Mailing Address - Fax:972-767-3471
Practice Address - Street 1:621 N MAIN ST STE 435
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9218
Practice Address - Country:US
Practice Address - Phone:469-556-5234
Practice Address - Fax:972-767-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568688760OtherNPI TYPE 1