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NPI Code Detail

MEDICARE: MINDFUL POSSIBILITIES LLC ROBERT COREY BOES SOLE MBR

MEDICARE: MINDFUL POSSIBILITIES LLC ROBERT COREY BOES SOLE MBR
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
11041C0700XClinical Social Worker
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1821730359
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL POSSIBILITIES LLC ROBERT COREY BOES SOLE MBR
Provider Business Mailing Address
First Line : 905 W CANTEY ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-3205
Country : US
Telephone Number : 817-382-1876
Fax Number :
Provider Business Practice Location Address
First Line : 905 W CANTEY ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-3205
Country : US
Telephone Number : 817-382-1876
Fax Number :
Authorized Official
Title or Position : FOUNDER
Name : ROBERT COREY BOES
Credential : LCSW-S
Telephone Number : 817-382-1876
Provider Enumeration Date : 04/13/2022
Last Update Date : 07/22/2024

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