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General NPI Number Information
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NPI Number | 1093341398
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Entity Type | Organization
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Legal Business Name | MINDFULPATH INC
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 22231 MULHOLLAND HWY STE 114
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City | CALABASAS
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State | CA
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Zip | 91302-5152
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Country | US
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Telephone | 818-400-5045
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Fax |
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Provider Business Mailing Address
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Address Line | 3872 LAS FLORES CANYON RD APT 2
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City | MALIBU
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State | CA
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Zip | 90265-5265
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Country | US
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Telephone | 818-400-5045
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Fax |
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Authorized Official
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Title or Position | CEO/LMFT
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Name | ERICA IVES
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Credential | MA, LMFT
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Telephone | 818-400-5045
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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