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General NPI Number Information
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NPI Number | 1669265047
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Entity Type | Organization
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Legal Business Name | THE MINDFUL MIND THERAPEUTIC COUNSELING AND CONSULTATION CENTER LLC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 613 FRANKLIN ST STE E
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-3411
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Country | US
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Telephone | 219-315-0644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8543
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City | MICHIGAN CITY
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State | IN
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Zip | 46361-8543
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Country | US
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Telephone | 219-315-0644
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | VERONICA C MARTIN
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Credential | M.A., LMHC
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Telephone | 219-315-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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