Healthcare Provider Details

I. General information

NPI: 1932837747
Provider Name (Legal Business Name): MINDFUL LIFE COMPANY LTD LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 WILLIAMS DR STE 220
GEORGETOWN TX
78628-2739
US

IV. Provider business mailing address

400 W JASPER DR STE 202
KILLEEN TX
76542-1322
US

V. Phone/Fax

Practice location:
  • Phone: 254-290-8577
  • Fax:
Mailing address:
  • Phone: 254-251-8750
  • Fax: 512-686-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MYKIA HOLLIS-GRIFFITH
Title or Position: OWNER
Credential: MA
Phone: 254-290-8577