MEDICARE: THE CENTER FOR MINDFUL EXPLORATION,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	101YP2500X	Professional Counselor	LPC006714	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205324191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR MINDFUL EXPLORATION,LLC

Provider Business Mailing Address
First Line	:	PO BOX 564
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-0010
Country	:	US
Telephone Number	:	706-443-5433
Fax Number	:	844-843-2957

Provider Business Practice Location Address
First Line	:	1200 WASHINGTON ST
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-4939
Country	:	US
Telephone Number	:	706-443-5433
Fax Number	:	844-843-2957

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN MARSHALL
Credential	:	LPC
Telephone Number	:	706-443-5433

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	03/11/2026

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