Healthcare Provider Details

I. General information

NPI: 1164938775
Provider Name (Legal Business Name): MINDFUL TRANSFORMATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S MAIN ST
BEL AIR MD
21014-5412
US

IV. Provider business mailing address

1015 S MAIN ST
BEL AIR MD
21014-5412
US

V. Phone/Fax

Practice location:
  • Phone: 667-231-4286
  • Fax:
Mailing address:
  • Phone: 667-231-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLC2933
License Number StateMD

VIII. Authorized Official

Name: KAREN POEHLMAN
Title or Position: OWNER
Credential: LCPC
Phone: 667-231-4286