Provider Demographics
NPI:1881388049
Name:MINDFUL HEALING THERAPY LLC
Entity type:Organization
Organization Name:MINDFUL HEALING THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSTING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-973-2451
Mailing Address - Street 1:1421 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3217
Mailing Address - Country:US
Mailing Address - Phone:918-973-2451
Mailing Address - Fax:
Practice Address - Street 1:1306 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2838
Practice Address - Country:US
Practice Address - Phone:918-973-2451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBERLY BOREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-08
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty