Healthcare Provider Details

I. General information

NPI: 1093341398
Provider Name (Legal Business Name): MINDFULPATH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22231 MULHOLLAND HWY STE 114
CALABASAS CA
91302-5152
US

IV. Provider business mailing address

3872 LAS FLORES CANYON RD APT 2
MALIBU CA
90265-5265
US

V. Phone/Fax

Practice location:
  • Phone: 818-400-5045
  • Fax:
Mailing address:
  • Phone: 818-400-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ERICA IVES
Title or Position: CEO/LMFT
Credential: MA, LMFT
Phone: 818-400-5045