MEDICARE: MINDFUL LIVING CENTER TEXAS EL PASO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1063344315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL LIVING CENTER TEXAS EL PASO LLC

Provider Business Mailing Address
First Line	:	900 PACIFIC COAST HWY APT 105
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4859
Country	:	US
Telephone Number	:	213-510-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-3504
Country	:	US
Telephone Number	:	915-286-6370
Fax Number	:

Authorized Official
Title or Position	:	VP OPERATIONS
Name	:	ERIK TOLONEN
Credential	:
Telephone Number	:	213-510-7904

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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