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General NPI Number Information
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NPI Number | 1700358603
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Entity Type | Organization
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Legal Business Name | MINDFUL PATH COUNSELING & WELLNESS PLLC
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 621 N MAIN ST STE 435
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City | GRAPEVINE
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State | TX
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Zip | 76051-9218
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Country | US
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Telephone | 469-556-5234
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Fax | 972-767-3471
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Provider Business Mailing Address
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Address Line | 621 N MAIN ST STE 435
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City | GRAPEVINE
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State | TX
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Zip | 76051-9218
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Country | US
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Telephone | 469-556-5234
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Fax | 972-767-3471
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REBECCA WALKER
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Credential |
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Telephone | 318-932-1463
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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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