Basic Information
| Provider Information | |||||||||
| NPI: | 1881007169 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINDFUL LIVING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8205 SPAIN RD NE STE 106 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871093155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053847352 | ||||||||
| FaxNumber: | 5052179165 | ||||||||
| Practice Location | |||||||||
| Address1: | 1216 SILVER AVE SW APT 3 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059081953 | ||||||||
| FaxNumber: | 5052747338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOWELL | ||||||||
| AuthorizedOfficialFirstName: | CARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5059081953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | M-08054 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.