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General NPI Number Information
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NPI Number | 1003442393
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Entity Type | Organization
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Legal Business Name | MINDFUL LIFE THERAPY
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 18411 CRENSHAW BLVD STE 432
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City | TORRANCE
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State | CA
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Zip | 90504-5042
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Country | US
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Telephone | 310-750-7448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 446
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City | REDONDO BEACH
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State | CA
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Zip | 90277-0446
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE FAMILY THERAPIST
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Name | ANGELICA GALVAN-NAVA
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Credential |
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Telephone | 310-750-7448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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