Provider Demographics
NPI:1881052397
Name:MINDFUL MATTERS CHILD & ADOLESCENT COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MINDFUL MATTERS CHILD & ADOLESCENT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:989-266-3421
Mailing Address - Street 1:111 E MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9780
Mailing Address - Country:US
Mailing Address - Phone:989-266-3421
Mailing Address - Fax:
Practice Address - Street 1:111 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9780
Practice Address - Country:US
Practice Address - Phone:989-266-3421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007631261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health