MEDICARE: MINDFUL WA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1508578204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL WA

Provider Business Mailing Address
First Line	:	230 AUBURN WAY S STE 1B
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-5451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 AUBURN WAY S STE 1B
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-5451
Country	:	US
Telephone Number	:	509-378-4558
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDEN J HEATH
Credential	:	PA-C
Telephone Number	:	509-378-4558

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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Directions to “MINDFUL WA ” Practice Location

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