Provider Demographics
NPI:1740715291
Name:MINDFUL PSYCHOTHERAPY SERVICES LLC
Entity type:Organization
Organization Name:MINDFUL PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-359-2727
Mailing Address - Street 1:9336 E GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-9033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1995
Practice Address - Country:US
Practice Address - Phone:262-458-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3088125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty