Healthcare Provider Details

I. General information

NPI: 1538094610
Provider Name (Legal Business Name): MINDFUL HEALING PSYCHOTHERAPY & ASSESSMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 MANZANA CT
CAMINO CA
95709-9547
US

IV. Provider business mailing address

3515 MANZANA CT
CAMINO CA
95709-9547
US

V. Phone/Fax

Practice location:
  • Phone: 530-957-2349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HERNANDEZ
Title or Position: CEO
Credential: PSY.D.
Phone: 530-957-2349