Provider Demographics
NPI:1770991465
Name:MINDFUL LIVING COUNSELING LLC
Entity type:Organization
Organization Name:MINDFUL LIVING COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC NCC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC NCC
Authorized Official - Phone:763-218-0868
Mailing Address - Street 1:300 E MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2468
Mailing Address - Country:US
Mailing Address - Phone:763-218-0868
Mailing Address - Fax:763-951-3097
Practice Address - Street 1:300 E MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2468
Practice Address - Country:US
Practice Address - Phone:763-218-0868
Practice Address - Fax:763-951-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00740251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health