Healthcare Provider Details

I. General information

NPI: 1811545692
Provider Name (Legal Business Name): MINDFULNESS JOURNEY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8406 MABLEY HILL RD
FENTON MI
48430-9454
US

IV. Provider business mailing address

8406 MABLEY HILL RD
FENTON MI
48430-9454
US

V. Phone/Fax

Practice location:
  • Phone: 248-805-2422
  • Fax: 800-308-7087
Mailing address:
  • Phone: 248-805-2422
  • Fax: 800-308-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TANYA PEETE
Title or Position: SOCIAL WORKER
Credential:
Phone: 248-702-5544