Healthcare Provider Details

I. General information

NPI: 1720911647
Provider Name (Legal Business Name): MINDFULLY HEALING MENTAL AND BEHAVIORAL WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DOGWOOD DR
BURLINGTON NJ
08016-9710
US

IV. Provider business mailing address

16 DOGWOOD DR
BURLINGTON NJ
08016-9710
US

V. Phone/Fax

Practice location:
  • Phone: 609-668-4719
  • Fax: 609-668-4719
Mailing address:
  • Phone: 609-668-4719
  • Fax: 609-668-4719

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BERTEE THOMAS JR.
Title or Position: EXECUTIVE MANAGER
Credential: PSYD
Phone: 609-668-4719