Healthcare Provider Details

I. General information

NPI: 1669337804
Provider Name (Legal Business Name): MINDHAVEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 WASHINGTON VILLAGE DR STE 113
DAYTON OH
45458-1847
US

IV. Provider business mailing address

8075 WASHINGTON VILLAGE DR STE 113
DAYTON OH
45458-1847
US

V. Phone/Fax

Practice location:
  • Phone: 513-360-8554
  • Fax:
Mailing address:
  • Phone: 513-360-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HOLLEY GRUENWALD
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 513-252-7792