Healthcare Provider Details

I. General information

NPI: 1558161646
Provider Name (Legal Business Name): MENDING INDIGENOUS SPIRITS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 S ORCHARD AVE UNIT 1132
UKIAH CA
95482-5044
US

IV. Provider business mailing address

671 S ORCHARD AVE UNIT 1132
UKIAH CA
95482-5044
US

V. Phone/Fax

Practice location:
  • Phone: 707-628-1500
  • Fax:
Mailing address:
  • Phone: 707-628-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State

VIII. Authorized Official

Name: NAOMI FRITZINGER
Title or Position: TREAURER
Credential:
Phone: 541-359-9525