MEDICARE: MINDFUL CHAPTER 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245059468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL CHAPTER LLC

Provider Business Mailing Address
First Line	:	4043 S 213TH CT
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-4248
Country	:	US
Telephone Number	:	425-365-1573
Fax Number	:

Provider Business Practice Location Address
First Line	:	4043 S 213TH CT
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-4248
Country	:	US
Telephone Number	:	425-365-1573
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH COUNSELOR
Name	:	MICHELLE CHRISTINE LAFFERRIERE
Credential	:	LMHC
Telephone Number	:	425-365-1573

Provider Enumeration Date	:	10/04/2024
Last Update Date	:	10/04/2024

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Directions to “MINDFUL CHAPTER LLC ” Practice Location

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