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General NPI Number Information
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NPI Number | 1053781765
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Entity Type | Organization
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Legal Business Name | MINDFUL LIFE PRACTICE, LLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 221 GARLAND ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2372
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Country | US
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Telephone | 231-486-0805
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Fax |
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Provider Business Mailing Address
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Address Line | 221 GARLAND ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2372
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Country | US
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Telephone | 231-486-0805
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | LINDA SMITH
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Credential | LMSW
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Telephone | 231-486-0805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401009566
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093556
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092522
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License Number State | MI
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