Healthcare Provider Details

I. General information

NPI: 1881007169
Provider Name (Legal Business Name): MINDFUL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 SILVER AVE SW APT 3
ALBUQUERQUE NM
87102-2986
US

IV. Provider business mailing address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-1953
  • Fax: 505-274-7338
Mailing address:
  • Phone: 505-384-7352
  • Fax: 505-217-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-08054
License Number StateNM

VIII. Authorized Official

Name: CARA HOWELL
Title or Position: OWNER
Credential: LMSW
Phone: 505-908-1953