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General NPI Number Information
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NPI Number | 1366371262
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Entity Type | Organization
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Legal Business Name | MINDFULLY TEXAS LLC
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Dates
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Enumeration Date | 05/16/2026
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Last Update Date | 05/16/2026
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Provider Practice Location Address
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Address Line | 1213 W SLAUGHTER LN STE 130A
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City | AUSTIN
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State | TX
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Zip | 78748-6900
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Country | US
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Telephone | 737-257-0829
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Fax | 800-853-9889
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Provider Business Mailing Address
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Address Line | 10290 ALLIANCE RD
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City | BLUE ASH
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State | OH
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Zip | 45242-4710
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Country | US
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Telephone | 737-257-0829
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Fax | 800-853-9889
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Authorized Official
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Title or Position | SVP
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Name | TIFFANY TAIT-MOSS
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Credential |
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Telephone | 954-380-1507
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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