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General NPI Number Information
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NPI Number | 1144981143
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Entity Type | Organization
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Legal Business Name | MINDFUL PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 921 STAMPEDE AVE
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City | CODY
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State | WY
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Zip | 82414-4522
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Country | US
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Telephone | 307-250-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 921 STAMPEDE AVE
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City | CODY
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State | WY
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Zip | 82414-4522
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Country | US
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Telephone | 307-250-2988
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DINA TASSIONE
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Credential | PH.D.
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Telephone | 307-250-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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