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General NPI Number Information
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NPI Number | 1669053047
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Entity Type | Organization
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Legal Business Name | MINDFUL LIFE COMPANY, PLLC
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Dates
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Enumeration Date | 04/18/2021
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Last Update Date | 10/16/2021
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Provider Practice Location Address
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Address Line | 2913 WILLIAMS DR STE 220
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City | GEORGETOWN
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State | TX
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Zip | 78628-2739
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Country | US
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Telephone | 254-251-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 6411 JOVANA
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City | KILLEEN
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State | TX
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Zip | 76542-5896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. MYKIA HOLLIS-GRIFFITH
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Credential | MA
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Telephone | 254-251-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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