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General NPI Number Information
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NPI Number | 1033945449
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Entity Type | Organization
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Legal Business Name | MINDFUL ALCHEMY COLLECTIVE
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 12968 SE 129TH CT
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-4335
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Country | US
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Telephone | 971-330-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 12968 SE 129TH CT
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-4335
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Country | US
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Telephone | 971-330-1382
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KELLY ALBINO
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Credential |
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Telephone | 971-330-1382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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