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General NPI Number Information
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NPI Number | 1063713493
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Entity Type | Organization
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Legal Business Name | MINDFUL THERAPEUTICS, LLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 10621 AIRPORT PULLING RD N SUITE 7
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City | NAPLES
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State | FL
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Zip | 34109-7333
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Country | US
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Telephone | 239-784-1080
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Fax |
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Provider Business Mailing Address
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Address Line | 10621 AIRPORT PULLING RD N SUITE 7
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City | NAPLES
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State | FL
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Zip | 34109-7333
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Country | US
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Telephone | 239-784-1080
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MRS. NANCY J FAIGHT-TARRETE
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Credential | LMHC
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Telephone | 239-784-1080
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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 | MH9238
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License Number State | FL
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