Provider Demographics
NPI:1801650585
Name:MINDFUL MOMENTUM THERAPY & WELLNESS, LLC
Entity type:Organization
Organization Name:MINDFUL MOMENTUM THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-471-5261
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ROCHDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01542-0023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:458 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1240
Practice Address - Country:US
Practice Address - Phone:508-471-5261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty