Healthcare Provider Details

I. General information

NPI: 1528972452
Provider Name (Legal Business Name): MINDFULLY WHOLE COUNSELING AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 ROBERT BLVD
SLIDELL LA
70458-1637
US

IV. Provider business mailing address

733 ROBERT BLVD
SLIDELL LA
70458-1637
US

V. Phone/Fax

Practice location:
  • Phone: 662-588-5143
  • Fax:
Mailing address:
  • Phone: 662-588-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAQUILA SMITH
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 662-588-5143