MEDICARE: MINDFUL LIFE THERAPY 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	:	1669056982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL LIFE THERAPY LLC

Provider Business Mailing Address
First Line	:	1 E HIGH ST
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2322
Country	:	US
Telephone Number	:	908-399-9024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E HIGH ST
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2322
Country	:	US
Telephone Number	:	908-399-9024
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	COURTNEY BATTISTA
Credential	:	LPC LCADC ACS
Telephone Number	:	908-399-9024

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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Directions to “MINDFUL LIFE THERAPY LLC ” Practice Location

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