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General NPI Number Information
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NPI Number | 1487307534
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Entity Type | Organization
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Legal Business Name | THE MINDFULNESS GYM LLC
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Dates
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Enumeration Date | 01/29/2022
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Last Update Date | 01/12/2025
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Provider Practice Location Address
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Address Line | 36400 WOODWARD AVE STE 202
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-0913
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Country | US
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Telephone | 248-633-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 10179 POKAGON LOOP
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City | FORT WAYNE
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State | IN
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Zip | 46818-0191
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Country | US
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Telephone | 248-633-8606
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Fax | 248-218-9367
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Authorized Official
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Title or Position | CEO/THERAPIST
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Name | ANDREW MOLDENHAUER
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Credential |
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Telephone | 248-633-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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