Healthcare Provider Details

I. General information

NPI: 1346932043
Provider Name (Legal Business Name): MINDFUL MOMENTUM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15500 VOSS RD STE 1084
SUGAR LAND TX
77498-4601
US

IV. Provider business mailing address

PO BOX 8223
HUNTSVILLE TX
77340-0004
US

V. Phone/Fax

Practice location:
  • Phone: 936-209-7485
  • Fax:
Mailing address:
  • Phone: 936-209-7485
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BEEMAN
Title or Position: OWNER
Credential:
Phone: 936-209-7485