Healthcare Provider Details

I. General information

NPI: 1649978982
Provider Name (Legal Business Name): MINDFUL HEALING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 S HOWELL AVE STE 503
MILWAUKEE WI
53207-5939
US

IV. Provider business mailing address

4915 S HOWELL AVE STE 503
MILWAUKEE WI
53207-5939
US

V. Phone/Fax

Practice location:
  • Phone: 262-282-3253
  • Fax: 414-212-8988
Mailing address:
  • Phone: 262-282-3253
  • Fax: 414-212-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. HERBERT C RAASCH
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: DNP, APNP, PMHNP-BC
Phone: 262-282-3253