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General NPI Number Information
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NPI Number | 1720979214
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Entity Type | Organization
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Legal Business Name | PATH T0 MINDFUL BALANCED MENTAL WELLNESS, INC
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 10315 WOODLEY AVE STE 123
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6953
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Country | US
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Telephone | 818-488-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 4051 DONEVA RD
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City | MOORPARK
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State | CA
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Zip | 93021-2910
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Country | US
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Telephone | 818-426-2612
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH THERAPIST
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Name | MRS. GRACIELA GONZALEZ
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Credential | LCSW
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Telephone | 818-426-2612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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