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General NPI Number Information
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NPI Number | 1023937174
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Entity Type | Organization
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Legal Business Name | MINDFUL PRACTICE CO. LLC
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 701 E REAGAN PKWY
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City | MEDINA
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State | OH
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Zip | 44256-1238
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Country | US
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Telephone | 614-285-4827
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | MEDINA
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State | OH
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Zip | 44258-0100
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Country | US
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Telephone | 614-285-4827
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Fax |
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Authorized Official
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Title or Position | OWNER/MENTAL HEALTH THERAPIST
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Name | KATELYN WAGNER
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Credential | LISW-S
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Telephone | 614-285-4827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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