Healthcare Provider Details

I. General information

NPI: 1922945534
Provider Name (Legal Business Name): MINDFULLY CONNECTED THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 STAGE RD STE 4
BARTLETT TN
38134-4568
US

IV. Provider business mailing address

3566 OAK LIMB CV
BARTLETT TN
38135-3079
US

V. Phone/Fax

Practice location:
  • Phone: 901-216-7450
  • Fax:
Mailing address:
  • Phone: 901-216-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS WANDA LYNETTE HORTON
Title or Position: OWNER
Credential: LPC-MHSP
Phone: 901-216-7450