Healthcare Provider Details

I. General information

NPI: 1295306355
Provider Name (Legal Business Name): MINDFUL BEHAVIORAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E R L THORNTON FWY STE 334
DALLAS TX
75228-7018
US

IV. Provider business mailing address

8811 TEEL PKWY STE 100-5476
FRISCO TX
75035-4201
US

V. Phone/Fax

Practice location:
  • Phone: 888-550-4842
  • Fax: 888-550-3391
Mailing address:
  • Phone: 888-550-4842
  • Fax: 888-550-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FAITH I OGALA
Title or Position: OWNER OF ENTITY
Credential: MSN, PMHNP-BC
Phone: 888-550-4842