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General NPI Number Information
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NPI Number | 1962681932
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Entity Type | Organization
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Legal Business Name | MINDFUL MEDICINE, INC.
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 3690 ORANGE PL STE 410
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City | BEACHWOOD
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State | OH
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Zip | 44122-4464
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Country | US
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Telephone | 216-292-6288
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Fax |
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Provider Business Mailing Address
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Address Line | 3690 ORANGE PL STE 410
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City | BEACHWOOD
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State | OH
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Zip | 44122-4464
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Country | US
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Telephone | 216-292-6288
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LINDA MARIE EHRENBEIT
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Credential |
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Telephone | 440-708-0598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35-071457B
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License Number State | OH
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