Healthcare Provider Details

I. General information

NPI: 1669927216
Provider Name (Legal Business Name): MINDFUL PARENTING GROUPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 30TH ST STE 205
SANTA MONICA CA
90405-3025
US

IV. Provider business mailing address

2665 30TH ST STE 205
SANTA MONICA CA
90405-3025
US

V. Phone/Fax

Practice location:
  • Phone: 310-766-2360
  • Fax:
Mailing address:
  • Phone: 310-766-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT34707
License Number StateCA

VIII. Authorized Official

Name: MS. DIANE PATRICIA REYNOLDS
Title or Position: PRESIDENT
Credential: M.A., MFT
Phone: 310-766-2360