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General NPI Number Information
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NPI Number | 1093264764
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Entity Type | Organization
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Legal Business Name | MINDFUL RELATIONSHIP INC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 221 ARLO RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3836
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Country | US
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Telephone | 646-641-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 221 ARLO ROAD
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City | STATEN ISLAND
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State | NY
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Zip | 10301
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Country | US
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Telephone | 646-641-7633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOUKAI CHEN
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Credential |
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Telephone | 646-641-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000773
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License Number State | NY
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