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General NPI Number Information
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NPI Number | 1669927216
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Entity Type | Organization
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Legal Business Name | MINDFUL PARENTING GROUPS, INC.
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 2665 30TH ST STE 205
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City | SANTA MONICA
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State | CA
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Zip | 90405-3025
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Country | US
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Telephone | 310-766-2360
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Fax |
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Provider Business Mailing Address
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Address Line | 2665 30TH ST STE 205
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City | SANTA MONICA
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State | CA
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Zip | 90405-3025
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Country | US
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Telephone | 310-766-2360
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DIANE PATRICIA REYNOLDS
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Credential | M.A., MFT
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Telephone | 310-766-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT34707
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License Number State | CA
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