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General NPI Number Information
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NPI Number | 1750156576
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Entity Type | Organization
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Legal Business Name | MINDFUL MINDS, INC.
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 730 MISSION ST STE 202
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3689
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Country | US
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Telephone | 510-910-1725
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Fax |
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Provider Business Mailing Address
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Address Line | 730 MISSION ST STE 202
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3689
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Country | US
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Telephone | 510-910-1725
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | KATRINA TATTENHAM
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Credential | LCSW
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Telephone | 510-910-1725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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