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General NPI Number Information
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NPI Number | 1457713489
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Entity Type | Organization
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Legal Business Name | MINDFUL LIVING LLC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 221 MAITLAND ST SUITE 204
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City | BEL AIR
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State | MD
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Zip | 21014-3939
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Country | US
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Telephone | 443-417-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 221 MAITLAND ST SUITE 204
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City | BEL AIR
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State | MD
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Zip | 21014-3939
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Country | US
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Telephone | 443-417-5851
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MINA REYES
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Credential | LCPC
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Telephone | 443-417-5851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC5702
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License Number State | MD
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