Healthcare Provider Details

I. General information

NPI: 1992312896
Provider Name (Legal Business Name): MINDFUL BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W ALEXIS RD STE 215
TOLEDO OH
43623-1300
US

IV. Provider business mailing address

3601 W ALEXIS RD STE 215
TOLEDO OH
43623-1300
US

V. Phone/Fax

Practice location:
  • Phone: 419-343-1484
  • Fax:
Mailing address:
  • Phone: 419-343-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS VICTORIA SANDOVAL
Title or Position: OWNER
Credential:
Phone: 419-290-1495