MEDICARE: MINDFUL STATES THERAPY PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1194609321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL STATES THERAPY PLLC

Provider Business Mailing Address
First Line	:	3 LOWER FALLS ESTS
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-9537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 LOWER FALLS ESTS
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-9537
Country	:	US
Telephone Number	:	304-881-3071
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEGHAN LIVELY
Credential	:	LICSW
Telephone Number	:	304-769-9554

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/08/2025

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