Basic Information
| Provider Information | |||||||||
| NPI: | 1679067490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINDFULNESS BASED INTERVENTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12 | ||||||||
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| City: | OURAY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814270012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703180529 | ||||||||
| FaxNumber: | 8554033931 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 SHERMAN ST | ||||||||
| Address2: | |||||||||
| City: | RIDGWAY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703180529 | ||||||||
| FaxNumber: | 8554033931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2018 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MOORMAN | ||||||||
| AuthorizedOfficialFirstName: | NICHOLE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9703180529 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.