Healthcare Provider Details

I. General information

NPI: 1417589722
Provider Name (Legal Business Name): MINDFUL TRANSFORMATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20008 CHAMPION FOREST DR STE 601
SPRING TX
77379-8696
US

IV. Provider business mailing address

20008 CHAMPION FOREST DR STE 601
SPRING TX
77379-8696
US

V. Phone/Fax

Practice location:
  • Phone: 281-892-9986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL GUY
Title or Position: MEDICAL BILLER
Credential:
Phone: 281-676-9052