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General NPI Number Information
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NPI Number | 1831819572
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Entity Type | Organization
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Legal Business Name | MINDFUL WELLNESS PSYCHOTHERAPY SERVICES LLC
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 208 PARK ST
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City | MORGANTOWN
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State | WV
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Zip | 26501-7518
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Country | US
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Telephone | 304-672-2384
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 EARL L CORE RD PMB1026
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City | MORGANTOWN
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State | WV
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Zip | 26505-7518
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Country | US
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Telephone | 304-316-6420
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MR. CHRISTOPHER BATTISTA LOPEZ
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Credential | MSW, LICSW
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Telephone | 304-672-2384
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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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