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General NPI Number Information
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NPI Number | 1558909119
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Entity Type | Organization
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Legal Business Name | MINDFUL JOURNEY, LLC
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 200 TURWILL LN STE 1
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City | KALAMAZOO
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State | MI
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Zip | 49006-4277
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Country | US
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Telephone | 269-350-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 839 UPTON AVE
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City | SPRINGFIELD
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State | MI
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Zip | 49037-4848
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Country | US
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Telephone | 810-444-6298
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Fax |
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Authorized Official
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Title or Position | LICENSED MASTER SOCIAL WORKER
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Name | KRISTEN LYNN HARRIS
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Credential | MSW, LMSW, CAADC, AD
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Telephone | 269-350-4677
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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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