MEDICARE: MINDFUL RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003765959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL RECOVERY LLC

Provider Business Mailing Address
First Line	:	300 N DAKOTA AVE STE 303
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-6026
Country	:	US
Telephone Number	:	605-303-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N DAKOTA AVE STE 303
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-6026
Country	:	US
Telephone Number	:	712-470-4022
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MARISSA KAY HASTINGS
Credential	:	LPC, LAC, NCC
Telephone Number	:	712-470-4022

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	03/04/2026

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