Healthcare Provider Details

I. General information

NPI: 1699634295
Provider Name (Legal Business Name): MINDFUL CHILD ASSESSMENT & COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OLYMPIC BLVD STE 225
WALNUT CREEK CA
94596-5070
US

IV. Provider business mailing address

360 LINDSEY DR
MARTINEZ CA
94553-5738
US

V. Phone/Fax

Practice location:
  • Phone: 925-954-9229
  • Fax:
Mailing address:
  • Phone: 925-954-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE EDWARDS
Title or Position: OWNER/DIRECTOR
Credential: LEP
Phone: 925-413-7968