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General NPI Number Information
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NPI Number | 1487892303
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Entity Type | Organization
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Legal Business Name | MINDFUL INNOVATIONS COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 8527 IVORY CREST DR
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City | CONVERSE
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State | TX
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Zip | 78109-3288
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Country | US
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Telephone | 210-788-2762
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Fax |
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Provider Business Mailing Address
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Address Line | 8527 IVORY CREST DR
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City | CONVERSE
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State | TX
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Zip | 78109-3288
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Country | US
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Telephone | 210-788-2762
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. GUILLERMO RODRIGUEZ
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Credential |
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Telephone | 210-788-2762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P-1477967-8
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License Number State | AZ
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