Healthcare Provider Details

I. General information

NPI: 1346006327
Provider Name (Legal Business Name): MINDFUL RIVER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9238 MADISON BLVD STE 116
MADISON AL
35758-9112
US

IV. Provider business mailing address

9238 MADISON BLVD STE 116
MADISON AL
35758-9112
US

V. Phone/Fax

Practice location:
  • Phone: 563-559-9813
  • Fax:
Mailing address:
  • Phone: 563-559-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNA THEMAS
Title or Position: OWNER
Credential: LPC
Phone: 563-559-9813