Healthcare Provider Details

I. General information

NPI: 1235845686
Provider Name (Legal Business Name): MINDFUL CONNECTIONS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 APPLEWOOD BLVD STE 1B
BOARDMAN OH
44512-4900
US

IV. Provider business mailing address

7847 INDIAN TRL
POLAND OH
44514-2669
US

V. Phone/Fax

Practice location:
  • Phone: 330-967-9950
  • Fax:
Mailing address:
  • Phone: 330-719-7692
  • Fax:

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANA KOPAS
Title or Position: OWNER
Credential:
Phone: 330-967-9950