Healthcare Provider Details

I. General information

NPI: 1316882889
Provider Name (Legal Business Name): MINDFUL MEADOWS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16794 VIA ALEGRIA
MORENO VALLEY CA
92551-2145
US

IV. Provider business mailing address

23580 ALESSANDRO BLVD UNIT 7661
MORENO VALLEY CA
92552-6035
US

V. Phone/Fax

Practice location:
  • Phone: 951-554-1494
  • Fax: 951-380-8484
Mailing address:
  • Phone: 951-554-1494
  • Fax: 951-380-8484

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: MS. DANIELLE CHERRIE CAMPBELL
Title or Position: OWNER
Credential: LCSW
Phone: 951-554-1494