Healthcare Provider Details

I. General information

NPI: 1063126563
Provider Name (Legal Business Name): MINDS MOVING FORWARD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRON POINT CIR STE 140
FOLSOM CA
95630-8594
US

IV. Provider business mailing address

PO BOX 5113
EL DORADO HILLS CA
95762-0003
US

V. Phone/Fax

Practice location:
  • Phone: 702-608-2622
  • Fax:
Mailing address:
  • Phone: 702-608-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: HANNAH WARE
Title or Position: PRESIDENT
Credential: LMFT
Phone: 702-608-2622