Healthcare Provider Details

I. General information

NPI: 1679390819
Provider Name (Legal Business Name): MINDFUL PATHWAY THERAPY AND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E MAIN ST
PRICE UT
84501
US

IV. Provider business mailing address

595 E MAIN ST
PRICE UT
84501-3136
US

V. Phone/Fax

Practice location:
  • Phone: 435-200-4784
  • Fax: 844-893-5798
Mailing address:
  • Phone: 435-200-4784
  • Fax: 844-893-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA TRIPP
Title or Position: MANAGING MEMBER
Credential:
Phone: 385-402-9015