MEDICARE: MINDFUL STORIES COUNSELING, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1245008630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL STORIES COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1030 EUCLID AVE APT 604
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1531
Country	:	US
Telephone Number	:	216-256-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 EUCLID AVE APT 604
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1531
Country	:	US
Telephone Number	:	216-256-0808
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	VANESSA WORTMANN
Credential	:	LISW
Telephone Number	:	216-256-0808

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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