=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508729674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDFUL GROWTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1730 RONDO ST SE
-----------------------------------------------------
City | KENTWOOD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49508-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-886-4117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1730 RONDO ST SE
-----------------------------------------------------
City | KENTWOOD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49508-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | JESSICA MARIE SWITEK
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 616-886-4117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------