Healthcare Provider Details

I. General information

NPI: 1598333924
Provider Name (Legal Business Name): MINDFUL MUSIC THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 CONGRESS ST APT A3
BRADFORD PA
16701-3993
US

IV. Provider business mailing address

440 CONGRESS ST APT A3
BRADFORD PA
16701-3993
US

V. Phone/Fax

Practice location:
  • Phone: 302-803-4794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRENT ROUNSVILLE
Title or Position: OWNER
Credential:
Phone: 302-803-4794