Healthcare Provider Details

I. General information

NPI: 1346732765
Provider Name (Legal Business Name): MINDFUL HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6575 S REDWOOD RD STE 240
SALT LAKE CITY UT
84123-5694
US

IV. Provider business mailing address

6575 S REDWOOD RD STE 240
SALT LAKE CITY UT
84123-5694
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-7712
  • Fax:
Mailing address:
  • Phone: 801-432-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200020-4405
License Number StateUT

VIII. Authorized Official

Name: MARTHA SOUTHWICK
Title or Position: OWNER/EMPLOYEE
Credential: NURSE PRACTITIONER
Phone: 801-432-7712