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General NPI Number Information
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NPI Number | 1730639048
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Entity Type | Organization
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Legal Business Name | MINDFULNESS MATTERS INSTITUTE
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 557 FOREST HILLS DRIVE
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City | BRECKENRIDGE
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State | CO
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Zip | 80424
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Country | US
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Telephone | 970-302-1796
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3699
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-3699
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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 | DIRECTOR
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Name | DR. KIMBERLY BUNDY-FAZIOLI
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Credential | PH.D., LCSW
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Telephone | 970-302-1796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 295
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License Number State | CO
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