MEDICARE: MINDFUL FAMILY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1336821859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL FAMILY SERVICES

Provider Business Mailing Address
First Line	:	9507 HULL STREET RD # I1
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1476
Country	:	US
Telephone Number	:	702-403-0325
Fax Number	:

Provider Business Practice Location Address
First Line	:	9507 HULL STREET RD STE I1
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1476
Country	:	US
Telephone Number	:	702-403-0325
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	MR. ARIC MELTON
Credential	:
Telephone Number	:	702-403-0325

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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Directions to “MINDFUL FAMILY SERVICES ” Practice Location

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