MEDICARE: MINDFUL MINDS 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1588364111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL MINDS COUNSELING LLC

Provider Business Mailing Address
First Line	:	51 W ELLIOT RD STE 102
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1311
Country	:	US
Telephone Number	:	480-486-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 W ELLIOT RD STE 102
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1311
Country	:	US
Telephone Number	:	480-486-2125
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MATTIE GAFFNEY
Credential	:
Telephone Number	:	480-486-2125

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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