Healthcare Provider Details

I. General information

NPI: 1053265470
Provider Name (Legal Business Name): MYNDFUL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19425 RAYFIELD DR
GERMANTOWN MD
20874-6257
US

IV. Provider business mailing address

19425 RAYFIELD DR
GERMANTOWN MD
20874-6257
US

V. Phone/Fax

Practice location:
  • Phone: 301-605-3997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE YAN
Title or Position: THERAPIST
Credential: LCSW-C
Phone: 301-605-3997