Provider Demographics
NPI:1750718409
Name:YOUR MINDFUL PATH COUNSELING AND YOGA, LLC
Entity type:Organization
Organization Name:YOUR MINDFUL PATH COUNSELING AND YOGA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-856-5079
Mailing Address - Street 1:4375 SCOTLAND CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8454
Mailing Address - Country:US
Mailing Address - Phone:678-856-5079
Mailing Address - Fax:770-982-2818
Practice Address - Street 1:4562 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE 123
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3641
Practice Address - Country:US
Practice Address - Phone:678-856-5079
Practice Address - Fax:770-982-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007365261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)