Healthcare Provider Details

I. General information

NPI: 1760024434
Provider Name (Legal Business Name): MINDFUL HARMONY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N. MAIN ST
HOMER NY
13077
US

IV. Provider business mailing address

67 N. MAIN ST
HOMER NY
13077
US

V. Phone/Fax

Practice location:
  • Phone: 607-218-2018
  • Fax: 607-930-4750
Mailing address:
  • Phone: 607-218-2018
  • Fax: 607-930-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE KOSLOWSKI
Title or Position: SOLE MEMBER
Credential: LAC
Phone: 607-218-2048