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NPI Code Detail

MEDICARE: MINDFUL MOMENTUM COUNSELING SERVICES PLLC

MEDICARE: MINDFUL MOMENTUM COUNSELING SERVICES 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1366298051
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL MOMENTUM COUNSELING SERVICES PLLC
Provider Business Mailing Address
First Line : 12222 MERIT DR STE 130
Second Line :
City : DALLAS
State : TX
Zip : 75251-3236
Country : US
Telephone Number : 254-419-4190
Fax Number :
Provider Business Practice Location Address
First Line : 12222 MERIT DR STE 130
Second Line :
City : DALLAS
State : TX
Zip : 75251-3236
Country : US
Telephone Number : 254-419-4190
Fax Number :
Authorized Official
Title or Position : LICENSED PROFESSIONAL COUNSELOR
Name : CANDICE LENORA SMITH
Credential :
Telephone Number : 254-419-4190
Provider Enumeration Date : 04/24/2024
Last Update Date : 04/24/2024

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Directions to “MINDFUL MOMENTUM COUNSELING SERVICES PLLC ” Practice Location

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