Provider Demographics
NPI:1831809474
Name:MINDFUL PATH COUNSELING
Entity type:Organization
Organization Name:MINDFUL PATH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGBRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:925-642-8845
Mailing Address - Street 1:101 W MORTON ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4038
Mailing Address - Country:US
Mailing Address - Phone:925-642-8845
Mailing Address - Fax:
Practice Address - Street 1:101 W MORTON ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4038
Practice Address - Country:US
Practice Address - Phone:925-642-8845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONGBRAKE CONSULTING & ADVOCACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty