Healthcare Provider Details

I. General information

NPI: 1073841276
Provider Name (Legal Business Name): MINDFUL PSYCHOTHERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2009
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 WESTWOOD DR STE 6
SAN JOSE CA
95125-5104
US

IV. Provider business mailing address

1541 CAMINO MONDE
SAN JOSE CA
95125-3704
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-3345
  • Fax: 858-800-4803
Mailing address:
  • Phone: 858-353-3345
  • Fax: 858-452-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY 23133
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 23133
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY 23133
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 23133
License Number StateCA

VIII. Authorized Official

Name: ARCHANA JAJODIA
Title or Position: PRESIDENT
Credential: PHD
Phone: 858-353-3345