Healthcare Provider Details

I. General information

NPI: 1033947312
Provider Name (Legal Business Name): MINDFUL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SENECA ST STE 107
SEATTLE WA
98101-3265
US

IV. Provider business mailing address

720 SENECA ST STE 107
SEATTLE WA
98101-3265
US

V. Phone/Fax

Practice location:
  • Phone: 206-805-9995
  • Fax:
Mailing address:
  • Phone: 206-805-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: IMAN YUNIS
Title or Position: EXECUTIVE DIRECTOR
Credential: NP
Phone: 206-805-9995