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General NPI Number Information
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NPI Number | 1255012969
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Entity Type | Organization
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Legal Business Name | MINDFUL SOUL THERAPEUTIC SOLUTIONS LLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 130 W WENGER RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2760
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Country | US
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Telephone | 937-626-6481
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Fax |
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Provider Business Mailing Address
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Address Line | 329 IMOGENE RD
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City | DAYTON
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State | OH
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Zip | 45405-5208
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Country | US
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Telephone | 937-626-6481
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IRIS M. BLANCHARD
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Credential | LPC, LICDC, SAP
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Telephone | 937-626-6481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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