Healthcare Provider Details

I. General information

NPI: 1225703226
Provider Name (Legal Business Name): THE MINDFUL OASIS CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11891 NEELYTON RD
SHADE GAP PA
17255-9247
US

IV. Provider business mailing address

11891 NEELYTON RD
SHADE GAP PA
17255-9247
US

V. Phone/Fax

Practice location:
  • Phone: 717-489-2949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NIKOLE BOSTON
Title or Position: OWNER
Credential:
Phone: 717-489-2949