Healthcare Provider Details

I. General information

NPI: 1295627495
Provider Name (Legal Business Name): MINDFUL VIBES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 VALLEY OAKS LOOP
GEORGETOWN TX
78626-7768
US

IV. Provider business mailing address

219 VALLEY OAKS LOOP
GEORGETOWN TX
78626-7768
US

V. Phone/Fax

Practice location:
  • Phone: 564-653-2595
  • Fax:
Mailing address:
  • Phone: 564-653-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAYANN SANDREA FOSTER
Title or Position: THERAPIST
Credential: LMHC, LPC
Phone: 564-652-2595