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General NPI Number Information
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NPI Number | 1902234453
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Entity Type | Organization
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Legal Business Name | MINDFUL LIFE IN ACTION
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 380 CLINE AVE STE 3
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City | MANSFIELD
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State | OH
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Zip | 44907-1056
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Country | US
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Telephone | 567-241-1543
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 290
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City | SHELBY
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State | OH
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Zip | 44875-0290
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Country | US
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Telephone | 567-241-1543
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. MARY M COX
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Credential | LISW-S, LICDC
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Telephone | 567-241-1543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ICDC131026
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | I1200473
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License Number State | OH
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