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General NPI Number Information
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NPI Number | 1801650585
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Entity Type | Organization
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Legal Business Name | MINDFUL MOMENTUM THERAPY & WELLNESS, LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 458 PLEASANT ST
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City | LEICESTER
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State | MA
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Zip | 01524-1240
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Country | US
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Telephone | 508-205-9806
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Fax | 508-762-4183
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Provider Business Mailing Address
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Address Line | 458 PLEASANT ST
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City | LEICESTER
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State | MA
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Zip | 01524-1240
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Country | US
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Telephone | 508-205-9806
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Fax | 508-762-4183
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | BRYANNA VAIL
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Credential | M.ED, LMHC
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Telephone | 508-205-9806
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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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