Healthcare Provider Details

I. General information

NPI: 1114644960
Provider Name (Legal Business Name): MINDFUL CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S 2000 W STE A105
SYRACUSE UT
84075-9612
US

IV. Provider business mailing address

618 S 1550 W
SYRACUSE UT
84075-8117
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-6397
  • Fax:
Mailing address:
  • Phone: 801-628-6397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTORIA THOMPSON
Title or Position: LCSW
Credential: LCSW
Phone: 801-628-6397