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NPI Code Detail

MEDICARE: MINDFULLY TEXAS LLC

MEDICARE: MINDFULLY TEXAS 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
1103TC0700XClinical Psychologist
21041C0700XClinical Social Worker
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1366371262
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFULLY TEXAS LLC
Provider Business Mailing Address
First Line : 10290 ALLIANCE RD
Second Line :
City : BLUE ASH
State : OH
Zip : 45242-4710
Country : US
Telephone Number : 737-257-0829
Fax Number : 800-853-9889
Provider Business Practice Location Address
First Line : 1213 W SLAUGHTER LN STE 130A
Second Line :
City : AUSTIN
State : TX
Zip : 78748-6900
Country : US
Telephone Number : 737-257-0829
Fax Number : 800-853-9889
Authorized Official
Title or Position : SVP
Name : TIFFANY TAIT-MOSS
Credential :
Telephone Number : 954-380-1507
Provider Enumeration Date : 05/16/2026
Last Update Date : 05/16/2026

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Directions to “MINDFULLY TEXAS LLC ” Practice Location

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